Phlebitis and

thrombophlebitis
 Phlebitis Overview

Phlebitis -inflammation of a vein.

Thrombophlebitis -a blood clot in the
vein causes the inflammation.
Thrombophlebitis usually occurs in leg
veins, but it may occur in an arm. The
thrombus (clot) in the vein causes pain
and irritation and may block blood flow
in the veins.
Phlebitis can occur in both the surface
(superficial) or deep veins.
 Superficial phlebitisaffects veins on the skin
surface. The condition is rarely serious and, with
proper care, usually resolves rapidly.
Sometimes people with superficial phlebitis also
get deep vein thrombophlebitis, so a medical
evaluation is necessary.

Deep vein thrombophlebitisaffects the larger

blood vessels deep in the legs.Blood
clots(thrombi) can form, which may break off
and travel to the lungs. This is a potentially life-
threatening condition calledpulmonary
embolism
 Causes
Phlebitis may occur spontaneously or
as a complication of a medical
procedure. Local trauma and injury to
a vein also increase the risk of
forming a blood clot
 Superficial phlebitis
There is usually a slow onset of a tender red area along the superficial
veins on the skin. A long, thin red area may be seen as the
inflammation follows the path of a superficial vein.

This area may feel hard, warm, and tender. The skin around the vein
may be itchy and swollen.

The area may begin to throb or burn.

Symptoms may be worse when the leg is lowered, especially when

first getting out of bed in the morning.

A low-gradefevermay occur.
 Sometimes phlebitis may occur at the site
where a peripheral intravenous (IV) line
was started. The surrounding area may be
sore and tender along the vein.

If an infection is present, symptoms may

include redness, fever, pain, swelling, or
breakdown of the skin.
 Thrombophlebitis migrans can be a
non-metastaticmanifestation of
malignancies such aspancreatic
carcinoma
 Deep vein thrombophlebitis
This can be similar in presentation to
superficial phlebitis, but some people may
have no symptoms.
The classic signs and symptoms include
redness, warmth, swelling, and pain in the
leg.

One may have pain and swelling

throughout the entire limb.
 Treatment
In general, treatment may include
support stockings and wraps to reduce
discomfort as well as medications such
as:
Analgesics
Antibiotics (if infection is present)
Anticoagulants (blood thinners) to
prevent new clots from forming
:
Elevate the affected area to reduce swelling.
Keep pressure off of the area to reduce pain
and decrease the risk of further damage.
Apply moist heat to reduce inflammation and
pain.
Surgicalremoval, stripping, or bypass of the
vein is rarely needed but may be
recommended in some situations.
 RISK FACTORS
Older age (> 40 years)
Male gender
Smoking
Diabetes mellitus
Hyperlipidemia
Hypertension
Hyperhomocysteinemia

When risk factors coexist, the risk increases

several-fold
 Symptoms

Most asymptomatic
Intermittant claudication
Rest pain
Ulcers and gangrene
INTERMITTENT CLAUDICATION (LEG
ATTACK)

Derived from the Latin word claudicatio i.e. to

limp
Caused by PAD in the lower extremities
Characterized by pain, ache, cramp, tightness or
sense of fatigue in leg muscles with activity
Symptoms relieved by rest
Results in reduced mobility and quality of life
 WHAT CAUSES INTERMITTENT
CLAUDICATION?

Atherosclerosis in peripheral arteries of legs

During exercise, oxygen demand increases

Muscles operate anaerobically

Produce lactic acid and other metabolites

Leg pain
Lactic acid and other metabolites washed away
on rest
 INTERMITTENT CLAUDICATION IS
INDICATIVE OF SYSTEMIC
ATHEROSCLEROSIS

40-60% of patients with intermittent

claudication have concomitant CAD
 PRIMARY SITES
OF INVOLVEMENT
Femoral & Popliteal
arteries: 80-90%

Tibial & Peroneal

arteries: 40-50%

Aorta & Iliac arteries:

30%
 DIAGNOSIS
History taking
Careful examination of leg
Pulse evaluation
Ankle-brachial index (ABI):
SBP in ankle (dorsalis pedis and posterior
tibial arteries)
___________________________________
SBP in upper arm (brachial artery)
 WHY IS IT NECESSARY TO TREAT
INTERMITTENT CLAUDICATION ?
Symptoms worsen in 25% of
patients
Approximately 5% will require
amputation within 5 years
Around 5-10% have critical limb
ischemia; risk of limb loss
 GOALS OF TREATMENT
To relieve exertional symptoms
and improve walking capacity
To improve quality of life
To reduce total mortality as well
as cardiac and cerebrovascular
morbidity and mortality
 MANAGEMENT
Risk factor modification
Exercise therapy
Antiplatelet therapy
Medical therapy targeted at symptoms
Revascularisation procedures
Amputation needed in some cases
Thank you