Venous disease is more common in society but less addressed than the peripheral arterial disease. Usually, people who are suffering from venous symptoms do not visit a doctor until it restricts him from regular work or when the pain and discomfort are intolerable. Mostly the patient waits with a hope that it will resolve spontaneously.

Thrombophlebitis is a common disease of the superficial veins that most commonly occurs in the lower extremities (especially in the long saphenous vein; vena saphena Magna) and often is connected with varicose veins.

It can also occur elsewhere, e.g. on the neck (external jugular vein), on the chest (Mondor’s disease), or in the upper extremities.

It is also common in the extremities after intravenous medication, infusion, or transfusion. Sometimes tight undergarments may also cause thrombophlebitis. Keeping the intravenous cannula for a long time is also a common cause.

Predisposing factors for superficial thrombophlebitis include damage to the venous intima (superficial trauma, drug infusion, intravenous use of illicit drugs), decreased venous flow (varices, chronic venous insufficiency, pregnancy, prolonged immobilization), increased thrombotic tendency (malignancy, coagulation disorder, hormonal therapy) or a combination of these.

However, the condition may also appear without any clear predisposing factor. It may be associated with vasculitis like Polyarteritis nodosa, Behcet's disease, and commonly Buerger's disease (i.e. thromboangiitis obliterans) which usually affects the small and medium-sized arteries in smokers.

Approximately one-third of patients with thromboangiitis obliterans also have superficial venous thrombi. Recurring superficial venous thrombi in a young person who smokes much suggests Buerger's disease.

The common clinical picture shows painful, reddish, and swollen affected venous areas. The vein is hard and tender on palpation. The patient usually complains of a painful cordlike structure on the limb, chest, abdomen, or elsewhere in the body.

Extensive phlebitis often is associated with fever and a mild increase of CRP level. In superficial thrombophlebitis, an inflammatory process of the venous wall is almost always present in addition to thrombosis. The prognosis of superficial thrombophlebitis is usually good.

A more extensive superficial venous thrombosis may spread to the deep veins. Deep venous thrombosis has been described to be associated with about 20% and pulmonary embolism with about 4% of superficial venous thrombosis that has been more than 5 cm in length.

The diagnosis is based mostly on clinical examination. Ultrasonography is helpful in differential diagnostics and it is recommended to exclude deep vein thrombosis. D dimer is not helpful.

Treatment aims to alleviate local symptoms as well as to prevent thrombosis from spreading into the deep veins and embolization to the lungs--. Symptoms may be alleviated with compressive stockings, cold compresses, and by keeping the leg elevated. Besides, topically administered NSAIDs may be used if needed.

A superficial venous thrombosis may spread to the deep veins. Deep vein thrombosis is more likely to spread either to the saphenofemoral junction in the groin or to the perforator veins in the popliteal area.

The recommended treatment (ACCP 2012) for superficial thrombophlebitis of ≥ 5 cm in length is either a mid-treatment dose of LMWH (e.g. enoxaparin 60 mg once daily) or with a prophylactic dose of fondaparinux (2.5 mg once daily) for 6 weeks.

Similar treatment is indicated if the thrombus is located (irrespective of its length) at a distance of less than 3 cm from the saphenofemoral junction located in the groin.2 6-week therapy with rivaroxaban (10 mg once daily) is also a good option.

During pregnancy, LMWH treatment is used and continued throughout pregnancy and for 6 weeks after the end of pregnancy.

If the criteria for anticoagulant therapy described above are not met, the patient may use oral NSAIDs, which alleviate symptoms but do not affect the thrombotic process.

Topically applied NSAID products can also be used as an addition to anticoagulation therapy. Topically applied anticoagulant cream may alleviate the symptoms of a local venous thrombosis, but there is no evidence that it would prevent the spreading of the thrombosis to the deep veins.

Antimicrobial therapy is not needed and it should only be commenced if the patient has another concomitant infection. Surgery appears not to be beneficial in the acute phase of superficial thrombophlebitis.

It is wise to address every single health issue to avoid future complications. Though in maximum cases thrombophlebitis occurs in a small area, sometimes it may create a big problem like deep vein thrombosis or rarely pulmonary embolism.

So, ignoring the symptoms may endanger life. Do not wait and observe for auto remission of pain and other symptoms. Consult your vascular surgeon as early as possible whenever you notice any symptom resembling thrombophlebitis.