Phlebitis, also known as superficial venous thrombosis or thrombophlebitis, affects the superficial veins of the legs, arms, sometimes the abdomen. It manifests itself with hardening of the affected vein , redness and pain. In addition, fever can sometimes also occur .
Although it is less serious than a deep vein thrombosis, it should never be underestimated , but instead diagnosed and treated promptly. Above all, we must look for the causes that caused it, because it can have serious complications, such as post-phlebitic syndrome or, in severe cases, cause pulmonary embolism.
The people most at risk of phlebitis are pregnant women, those who are following a hormonal treatment, those who are immobilized for a long time in bed, those who have varicose veins . But also those who have undiagnosed inflammatory diseases and other specific diseases that slow or alter blood flow and those who wear a central venous catheter.
In addition, the diagnosis is made with a venous echo- color Doppler and with a visit to a specialist, who, depending on the case, will administer anticoagulants , anti-inflammatories and / or antibiotics .
Finally, to prevent phlebitis it is good to maintain an active lifestyle, follow a healthy diet, not be overweight and avoid smoking.
Blood circulation: how it works
Veins are vessels that bring blood from the periphery to the heart , “dirty” blood, because it is full of waste and low in oxygen, which the heart sends to the lungs to clean itself.
Hence, the blood is liquid because it must flow easily into the arteries and veins , bringing oxygen and nourishment. In addition, it collects toxins and waste, to be disposed of through the filter organs, especially the lungs, kidneys, liver, etc. If the blood stops or slows down, it clots.
Clots and thrombi
A clot is the result of the transformation of blood from liquid to gel and then to crust. It is a phenomenon that we often see on our skin when we get injured.
However, blood always clots for a good intention:
- stop a bleeding
- healing an inflamed and diseased wound or tissue is in itself a good, non-harmful clot.
If the clot forms in an artery or vein it is called a thrombus . In fact, it has to do its job of healing the wound, stopping bleeding, healing inflammation. But it must also melt quickly, otherwise it takes up space and stops the circulation causing ischemia .
Veins and arteries are elastic tubes lined with tiles (endothelium) adhering to each other. When a wound, an inflammatory process or a virus interrupts this compact surface, the underlying “cement” is exposed. Then, the blood clotting system intervenes by forming a thrombus to heal the lesion .
The first to intervene are the platelets that quickly buffer the wound . Then they activate the clotting factors that complete the healing process by forming fibrin.
The danger of the thrombus
Thrombus becomes dangerous when:
- it is of considerable size
- it does not melt quickly after doing its job
- it releases emboli that travel in the blood and close veins or arteries causing embolism / heart attack / ischemia in a point far from where it was formed.
Its danger depends on:
- type of vessel in which it is formed (whether artery or vein)
- pot size
- importance of cells that remain oxygen-free.
For example, if thrombus forms in an artery , it blocks the arrival of oxygen and causes ischemia and heart attack. Instead, if it forms in a vein , it slows down the return of blood to the heart , the cells remain suffocated and crushed without nourishment.
In addition, arterial thrombosis is severe because it causes a heart attack, but venous thrombosis can cause pulmonary embolism , resulting in a lung attack.
Superficial (phlebitis) and deep vein thrombosis
It can be of different types:
- Superficial vein thrombosis (TVS): commonly called phlebitis or thrombophlebitis, it affects the superficial veins, often in the legs or arms, sometimes on the abdomen. It is however a real thrombosis, perhaps less serious than deep thrombosis, but never to be underestimated because the thrombus that forms for example in a saphenous vein can extend up to the vein of the thigh and release emboli exactly like a deep thrombosis.
Usually it manifests itself with heat and redness and hardening of a visible vein because it is superficial. If confirmed quickly with a venous echo-color Doppler it can be treated appropriately and not leave outcomes or create complications.
- The deep vein thrombosis (DVT) affects the deepest veins of the legs, arms, liver, around the abdomen, the brain. The obstacle to blood circulation causes serious symptoms such as very evident pain and swelling, or very little of all this: but it can release emboli that reach the heart and from there are pushed into the lung causing pulmonary embolism.
Finally, all thromboses are identified with the name of the affected organ :
- retinal vein thrombosis
- of the lower or upper limb
- kidney, etc.
What is phlebitis
It is a superficial venous thrombosis with an evident inflammatory component that causes hardening of the vein, redness and pain.
It can occur in a vein in the leg below or above the knee (saphenous vein). Hence, it can be the early indicator of an inflammatory bowel disease , kidney stones, gallstones, suffering from an abdominal organ or elsewhere. In addition, it can also be triggered by an insect bite, from a trauma, autoimmune chronic diseases .
It often occurs in the vein from which blood has been drawn or a catheter inserted for intravenous drug delivery. In fact, the vein wall is inflamed , hardens and a thrombus is formed inside it.
It should never be underestimated, it must be diagnosed, treated and the causes that may have caused it must be sought.
In reality, the superficial term must not mislead us , phlebitis or superficial venous thrombosis must also be considered an event worthy of further study , especially when it recurs.
In addition, it can also affect young people , often after a trauma or after violent muscle exercise that involves a rapid increase in muscle (for example in rowing machines or in those who do weight training).
As with all venous thromboses, the causes that can cause phlebitis can be transitory :
- inflammatory diseases
- hormonal therapies
- prolonged immobilization
But it can also hide a genetically predisposing structure (mutations for thrombophilia) or a temporary imbalance of the balance between pro and anticoagulant factors as occurs during hormone therapy or pregnancy .
In addition, the risk factors for superficial venous thrombosis are:
- venous stasis : slowing of the return of blood to the heart because obstacles such as a globular abdomen due to excess abdominal and visceral fat or pregnancy are present.
- Alterations of coagulation or of the spontaneous dissolution of the clot (fibrinolysis): it is an imbalance of coagulation factors that increases blood density, or a defect in anticoagulant factors or, again, an excess of procoagulant factors.
- Endothelial dysfunction (the endothelium is the innermost layer of the walls of the vessels).
Phlebitis: those who risk more
- presence of dilated (varicose) veins that have lost elasticity
- previous phlebitis
- removal or ligation of saphenous veins by any method (chemical, surgical, laser, radiofrequency)
- hormonal / birth control therapies
- known or undiagnosed inflammatory diseases
- long stay in bed or immobilization due to trauma, plastering , prolonged immobility for a trip by plane or car in uncomfortable conditions. In fact, these conditions create a stagnation or a slowing of the blood flow from the legs
- pregnancy and postpartum period
- previous venous thrombosis , personal or of a related family member
- elevated homocysteine levels in the blood
- thyroid disease
- inflammatory diseases of the ovaries or uterus
- tumors, occult or diagnosed, which slow down the circulation or confuse the system by releasing procoagulant substances into the blood
- hereditary thrombophilia , such as the Leiden factor V mutation or prothrombin factor II or other coagulation factors
- withdrawals, central venous catheters for the administration of drugs such as in chemotherapy , intravenous infusion via drip.
None of the situations described above is capable of causing thrombosis on its own, the presence of multiple risk factors increases the probability that the system will become unbalanced and lose control, generating thrombosis.
Chronic venous disease
It is the result of multiple undiagnosed thromboses , not properly treated for an appropriate amount of time and underestimated. It becomes a chronic syndrome with a strong impact on the quality of life. In fact, it causes stagnation, painful ulcers, which become infected and do not heal .
Chronic venous disease affects women more than men, with a 3: 1 ratio.
With chronic venous disease the walls of the veins lose elasticity , the valves that help the return of blood to the heart get damaged, the veins dilate causing:
- swelling and heaviness in the legs
- cramps in the calves and ankles
- appearance of capillaries and varices up to the appearance of torpid ulcers that heal with great effort.
Symptoms, if thrombosis is not recognized and adequately treated, become persistent and worsen over time.
The advice is to consult a specialist who will be able to suggest the appropriate therapy . In addition, he will investigate the causes that may have caused phlebitis, relating to the family doctor and to the specialists who have treated the patient for previous pathologies. However, it is also important to perform a venous echo-color Doppler that confirms and details the diagnosis.
In fact, this is not an aesthetic problem, but a functional one , because the veins in the legs become a weakness that can contribute to provoking more serious vascular events, not only in the veins but also in the arteries .
The signs of a phlebitis are quite evident in the vein and in the affected area and are manifested by:
- redness and hardening of a superficial vein with the appearance of a palpable hard cord in the acute phase
- sometimes more or less high fever.
In addition, the leg or arm affected by phlebitis can swell even at rest, they are hot and red, painful. One has the feeling of having a cramp that never goes away.
Finally, the symptoms may be more pronounced when the leg is stretched out or as soon as you get out of bed in the morning.
Once formed, the thrombus can dissolve on its own , thanks to our natural defense mechanisms (fibrinolysis). But it can also extend inside the affected vessel , increasing in volume, in the direction of the heart.
Furthermore, it can fragment, releasing small or large emboli that travel in the blood and reach the lung causing pulmonary embolism .
If phlebitis is not treated correctly , promptly and for a suitable amount of time, it tends to occur again , or to leave serious structural consequences on the veins and skin, such as:
- dark spots on the skin of the affected area
- appearance of new recurrent phlebitis / thrombophlebitis
- ulcer (serious complication often associated with high fever, appearance of purulent material and bad smell due to the overlap of infection by the bacteria that habitually stay on our skin)
- extension and release of emboli (venous thromboembolism): the fragments of the thrombus that travel in the venous circulation, from the superficial circle pass to the deep circle occupying increasingly important veins and transforming superficial thrombosis into a deep thrombosis, with an increase in the probability of pulmonary embolism , with pulmonary infarction, severe respiratory symptoms and risk to life.
Furthermore, if treated poorly, thrombosis returns and destroys the valve system contained in the veins , ruining their elasticity and facilitating the appearance of new phlebitis / thrombosis, and causing the appearance of varicose veins or ulcers (post phlebitic syndrome).
It is the consequence of repeated and underestimated thrombosis especially in the legs:
- swelling persists
- affected leg is perceived as “heavy”
- skin stains until it becomes blackish
- veins are showy, dilated and tortuous.
In severe cases, ulcers may appear, often at the ankle, which heal with difficulty and often become infected.
Symptoms can occur almost immediately after phlebitis, but more often after a few months to a year. Aside from the aesthetic problem, which is certainly not pleasant, the legs with post phlebitic syndrome are often fatigued, swollen and painful , especially after long periods of standing.
It cannot be based on symptoms alone, because it is unreliable.
If phlebitis is suspected, it is essential to seek medical attention immediately, who will perform a venous echo-color doppler and take a blood sample to measure the D-dimer . It is a simple diagnosis that allows you to quickly intervene with appropriate drugs if confirmed, and avoid future trouble.
You must suspect a thrombosis and then seek medical attention immediately when:
- The symptoms described are manifested in a person who has previously had thrombosis or phlebitis in the past
- the person is back from surgery
- take hormonal therapies such as birth control pills
- pregnancy or in the period after childbirth (40 days)
- in bed for some time for an illness, especially if with a fever
- wears a central venous catheter for chemotherapy.
In addition to treating the part affected by phlebitis, it is also important to investigate the balance of the coagulation system and to intervene on what can be corrected. Otherwise, once a thrombosis is cured, another one will form, in the same part of the body or in another organ.
In case of suspicion of phlebitis, it is therefore necessary to contact a specialist, who will perform a venous echo-color Doppler to evaluate the degree and extent of venous inflammation and who will look for the causes that may have contributed to causing it, to treat them or take them into account for the duration and type of care.
Venous Echocolordoppler: what it is
It is an ultrasound of the vessels that uses colored values (color) and ultrasound (doppler). It is a non-invasive examination that serves to verify venous circulation, both superficial and deep.
D-dimer dosage: what it is and values
It is a simple, inexpensive blood test, recommended in case of phlebitis to check for inflammation. D-dimer is the “ash” of the fire caused by inflammation due to the effect of thrombosis. If the result is negative, the probability that it is a true thrombosis is low, if instead the result is positive, there is a high probability that there is a true thrombosis. In the case of phlebitis this examination must always be performed in combination with the venous echo-color Doppler.
The doctor will evaluate the therapy to be administered based on the type of phlebitis and its state.
In fact, phlebitis or more correctly thrombophlebitis or superficial venous thrombosis must be treated with the same attention that is reserved for deep vein thrombosis. The cure consists in the administration of anticoagulant drugs and in some cases also of anti-inflammatories to resolve the strong inflammatory component . But the anti-inflammatory alone does not resolve the thrombosis underlying thrombophlebitis, they can only alleviate the symptoms.
For this reason, heparin and its derivatives such as fondaparinux form the basis of the treatment of superficial venous thrombosis or thrombophlebitis.
In fact, these drugs make the blood smoother than normal and allow the spontaneous dissolution mechanisms of the thrombus to dissolve it and heal the disease. In addition, antibiotics may also be prescribed in the presence of an infection.
Finally, if well tolerated, the elastic stocking , in cotton and not in nylon , is necessary , possibly with hold-ups that support all the venous circulation of the leg.
Finally, natural remedies may also help , which make pain more tolerable but are never decisive. These include those products that are found in pharmacies or herbal medicine, in the form of creams, gels or tablets, containing flavonoids, substances that promote microcirculation and the strengthening of the venous walls.
Tips to improve circulation
In the morning, after personal hygiene, before dressing:
- lie on the bed;
- raise the legs on the headboard to help empty the superficial veins;
- always with the legs raised, contract the calves, rotate the ankles and stretch the toes (this short and simple muscle activity helps the blood to return quickly to the heart and the legs become pale, a sign of effectiveness of the procedure);
- run everything for 5 minutes;
- massage the legs with talcum powder, from the foot towards the groin
- then wear elastic stockings.
The advice is to wear socks during the day especially if you plan to spend a lot of time on your feet.
How to promote venous circulation at night
Instead, elastic stockings are not necessary at night.
To promote venous circulation, especially after a thrombosis or in risky conditions such as pregnancy or the postpartum period , place two supports at least ten centimeters below the foot of the bed or the net.
Instead, avoid putting them under the mattress because during the night the legs tend to bend and slide downwards, negating the effectiveness of this system, so that the whole bed is tilted with the feet higher than the head.
In addition to elastic stockings, it would be useful to practice swimming, not in the acute phase of phlebitis naturally.
Also in summer, walk in the sea water immersed up to the thighs, walk a lot and do not expose your legs to the sun during the hottest hours .
The best prevention is the knowledge and correction of a dangerous lifestyle:
- less smoke
- less fat, especially on the abdomen and thighs
- a lot of structured and methodical aerobic physical activity
- cardiological checks
- normalization of the levels of known risk factors.
An intelligent lifestyle is important in healthy people, but it becomes mandatory and fundamental in those who have already had a thrombosis disease.
How to prevent phlebitis with nutrition
As for nutrition, this plays an important role in preventing phlebitis. It is therefore necessary:
- reduce the consumption of fatty and fried foods
- eat 5 portions a week of blue fish cooked in a healthy way without frying and with a little salt
- consume 5 servings a day of vegetables and fruit
- drink plenty of water during the day, between meals and low in salt.
The foods that contain natural antioxidants such as flavonoids may help maintain the health and elasticity of the veins. Furthermore, they counteract the formation of free radicals and therefore cutaneous and cellular aging. Therefore they contribute to reducing the risk of thrombosis and thrombophlebitis by acting also on the small capillaries.
Flavonoids are mainly contained in colored fruits and vegetables, but also in other foods:
- soya beans
- citrus fruits
- red berries and strawberries
With the advice of Specialists in Hematology and Cardiovascular Diseases from Thrombosis
External link : Phlebitis