Description

• Superficial thrombophlebitis is an inflammatory condition of the veins with secondary thrombosis.
• Traumatic thrombophlebitis types:
  • Injury
  • IV catheter related
  • Intentional (i.e., sclerotherapy)
• Septic (suppurative) thrombophlebitis types:
  • Iatrogenic, long-term IV catheter use
  • Infectious, mainly syphilis and psittacosis
• Aseptic thrombophlebitis types:
  • Primary hypercoagulable states: Disorders with measurable defects in the proteins of the coagulation and/or fibrinolytic systems
  • Secondary hypercoagulable states: Clinical conditions with a risk of thrombosis
• Mondor disease:
  • Rare presentation of anterior chest/breast veins of women
• System(s) affected: Cardiovascular
• Synonym(s): Phlebitis; Phlebothrombosis

Geriatric Considerations
Septic thrombophlebitis is more common; prognosis is poorer.

Pediatric Considerations
Subperiosteal abscesses of adjacent long bone may complicate the disorder.

• Associated with increased risk of aseptic superficial thrombophlebitis
• NSAIDs are contraindicated.

Epidemiology

• Predominant age:
  • Traumatic/IV related has no predominate age/sex
  • Aseptic primary hypercoagulable state:
    • Childhood to young adult
  • Aseptic secondary hypercoagulable state:
    • Mondor disease: Women, ages 21–55 years
    • Thromboangiitis obliterans onset: Ages 20–50 years
• Predominant sex:
  • Suppurative: Male = Female
  • Aseptic:
    • Mondor: Female > Male (2:1)
    • Thromboangiitis obliterans: Female > Male (1–19% of clinical cases)

• Septic:
  • Incidence of catheter-related thrombophlebitis is 88/100,000 persons.
  • Develops in 4–8% if cutdown is performed
• Aseptic primary hypercoagulable state: Antithrombin III and heparin cofactor II deficiency incidence is 50/100,000 persons.
• Aseptic secondary hypercoagulable state:
  • In pregnancy, 49-fold increased incidence of phlebitis
  • Superficial migratory thrombophlebitis in 27% of patients with thromboangiitis obliterans

• Superficial thrombophlebitis is common.
• 1/3 of patients in a medical ICU develop thrombophlebitis that eventually progresses to the deep veins.

Risk Factors

• Nonspecific:
  • Immobilization
  • Obesity
  • Advanced age
  • Postoperative states
• Traumatic/Septic:
  • IV catheter (plastic > coated)
  • Lower extremity IV catheter
  • Cutdowns
  • Cancer, debilitating diseases
  • Burn patients
  • AIDS
  • Varicose veins
• Aseptic:
  • Pregnancy
  • Oral contraceptives
  • Surgery, trauma, infection
  • Hypercoagulable state (i.e., factor V, protein C or S deficiency, others)
• Thromboangiitis obliterans: Persistent smoking
• Mondor disease:
  • Breast cancer or breast surgery

Genetics
Not applicable other than hypercoagulable states

General Prevention

• Avoidance of lower extremity cannulations/IV
• Insertion under aseptic conditions, securing cannulas, and replacing q72h
• Avoiding stasis or using usual deep vein thrombosis (DVT) prophylaxis in high-risk patients (i.e., ICU, immobilized)

Pathophysiology

• Similar to DVT and Virchow triad. A combination of vessel trauma, stasis, and hypercoagulability whether it is genetic, iatrogenic, or idiopathic
• Mondor disease pathophysiology not completely understood

Etiology

• Septic:
  • Staphylococcus aureus, Pseudomonas, Klebsiella, Peptostreptococcus sp.
  • Candida sp.
• Aseptic primary hypercoagulable state:
  • Due to inherited disorders of hypercoagulability
• Aseptic secondary hypercoagulable states:
  • Malignancy (Trousseau syndrome: Recurrent migratory thrombophlebitis): Most commonly seen in metastatic mucin or adenocarcinomas of the GI tract (pancreas, stomach, colon, and gallbladder), lung, prostate, and ovary
  • Pregnancy
  • Oral contraceptives
  • Behçet, Buerger, or Mondor disease