The veins of the leg are vulnerable to two types of blockage caused by clots: phlebitis, in which a superficial vein becomes blocked and inflamed, and acute deep venous thrombosis, in which a clot occludes an inner vein. The latter is the more serious of the two because it can lead to a pulmonary embolism, stroke, or heart attack, if a piece of the clot breaks away and enters the circulation. The cause of superficial phlebitis is unknown, although it generally develops in older people, often after an injury or prolonged period of inactivity. Varicose veins also increase the likelihood of phlebitis. The symptoms are usually unmistakable: the blocked vein becomes swollen, inflamed, and very painful. There may also be a fever. In contrast, a deep venous thrombosis often does not produce any obvious symptoms until the person suffers a pulmonary embolism or another life threatening consequence. Being bedridden for a time is a common precipitating factor because inactivity reduces blood flow in the legs, giving clots a chance to form. Other causes include the use of birth control pills or other products containing estrogen, recent childbirth or miscarriage, paralysis, a clotting disorder, and cancer. Smoking also increases the risk of deep venous thrombosis.
Diagnostic Studies And Procedures
To diagnose superficial phlebitis, a doctor will look at the area and feel the vein. Doppler ultrasonography, in which high frequency sound waves are used to study blood flow, may be ordered to confirm the diagnosis. A deep venous thrombosis is more difficult to diagnose, but Doppler ultrasound and venography, special X-rays taken following the injection of a dye into a vein, can detect most blockages.
Medical Treatments
Treatment depends upon whether the clot is in a superficial or a deep vein. Superficial phlebitis can usually be managed with self treatment and an anti inflammatory drug such as indomethacin . If a deep vein is blocked, one large intravenous dose of heparin, an anti clotting drug, will be given, followed by periodic injections of smaller doses over several days. In some cases, streptokinase or urokinase , which dissolve blood clots, may be administered also. As the condition improves, the patient will usually be started on warfarin , an oral anticlotting agent, and tapered off heparin. Depending upon the site of the thrombosis, warfarin will be continued for one to six months, then reduced gradually. In complicated cases, surgery may be necessary to remove the clot or insert a graft to bypass the occluded vein. Recurrent phlebitis also may be treated surgically by tying off and stripping the affected veins. Rather than wait for a deep thrombosis to develop, some doctors will advocate preventive measures, such as long term or even life long anticoagulant therapy for their high risk patients. Another preventive strategy calls for low dose of heparin to be administered prior to any operation and continued for several days afterwards. Bedridden patients should also wear special elastic surgical stockings. High risk patients, such as those who have developed a pulmonary embolism despite anticoagulant therapy, may have an umbrella like device implanted in the lower vena cava the large vein that carries blood from the lower extremities back to the heart-in order to prevent the passage of clots.
Alternative Therapies
Physical Therapy
A physical therapist might be engaged to make sure that an immobilized patient moves his legs periodically. Passive exercises, in which a therapist exercises the patient’s limbs. are used for persons who are unable to move on their own. The patient is encouraged to move about as soon as possible, at first simply by moving the legs in bed, then sitting up with legs dangling over the edge, and finally, by walking around.
Self Treatment
Superficial phlebitis usually can be self treated as follows:
- Keep the affected leg elevated a few feet above the floor when possible.
- Apply warm wet compresses to the area several times a day.
- Wear surgical or prescription elastic stockings to promote blood flow.
- If your doctor approves, take aspirin, ibuprofen, or other non-steroidal anti inflammatory medication.
To prevent future attacks, exercise every day to promote leg circulation. A brisk walk is ideal, but if this is not feasible, try an exercise cycle or low impact aerobics. During long trips and long hours seated at work, stretch your legs every hour. Also ask your doctor about long term use of surgical stockings and low dose aspirin therapy Anyone who suffers from phlebitis should refrain from smoking, and women with this or other clotting problems should not take oral contraceptives or estrogen replacement therapy.
Other Causes of phlebitis Symptoms
Bacterial cellulitis, inflammation and infection of the connective tissue, can produce symptoms similar to those of phlebitis, as can lymphangitis, an inflammation of the lymph channels.