Phlebitis is an acute or chronic inflammation of the venous wall. It can develop as a result of exposure to various factors, however, it is most often a complication of varicose veins of the lower extremities. The disease rarely occurs in isolation. Changes in the venous wall as a result of inflammation, as a rule, lead to the formation of blood clots and the transition of disease to thrombophlebitis. Modern research methods such as ultrasound and duplex scanning help the doctor diagnose phlebitis. Treatment is conservative, including anti-inflammatory therapy and physiotherapy.
I80 Phlebitis and thrombophlebitis
Phlebitis is an inflammatory process in the wall of a venous vessel. It can develop as a result of exposure to various factors, however, it is most often a complication of varicose veins of the lower extremities. The disease rarely occurs in isolation. Changes in the venous wall as a result of inflammation, as a rule, lead to the formation of blood clots and the transition of phlebitis to thrombophlebitis. Disease affects 1% of women and 0.7% of men over the age of 50.
Most often, phlebitis of the lower extremities occurs with varicose veins. The second most common is phlebitis, which is a complication of an abscess, an infected wound or an infectious disease. Inflammation of the venous wall can be caused by various pathogens, however, streptococcus acts most often as an infectious agent. Phlebitis can develop after a chemical burn of a vein. In certain situations, phlebitis is caused artificially. Thus, in the treatment of varicose veins, modern phlebology widely uses the method of sclerotherapy, the principle of which is based on the introduction into the vein of a special substance that causes aseptic phlebitis and subsequent gluing of the walls of the vein.
By localization of inflammation in the venous wall:
- Periphlebitis is phlebitis with a predominant lesion of the outer shell of the vein. As a rule, it develops when the inflammatory process spreads from the surrounding tissues to the walls of the vein.
- Endophlebitis is a phlebitis with a predominant lesion of the inner lining of the vein. Occurs as a result of damage to the inner venous membrane or injury to a vein. The cause of endophlebitis may be vein catheterization or prolonged needle stay in the vein with drip administration of various drugs. Endophlebitis is one of the side effects of intravenous administration of a hypertonic solution.
- Panphlebitis is phlebitis with the defeat of all the membranes of the vein.
- Allergic. Occurs as a result of an allergic reaction. Prone to chronic benign course.
- Painful. Affects the lower extremities. Usually develops after childbirth. It flows acutely. It is accompanied by a pronounced pain syndrome.
- Migrating (migratory thrombophlebitis). It occurs more often in young men. The superficial veins of the upper and lower extremities are involved in the process. Accompanied by a lesion of the arteries. It is prone to a long-term recurrent course.
- Cerebral. Affects the vessels of the brain. Usually develops as a result of infection.
- Pileflebitis. Inflammation of the collar vein (pileflebitis) is a complication of inflammatory processes in the abdominal cavity.
Phlebitis of infectious genesis can develop in any area of the human body.
With acute superficial phlebitis, the vein becomes painful, tense. The skin over the affected area turns red, thickens. Local hyperthermia is observed. There may be red stripes along the course of inflamed veins. In some cases, there is an increase in body temperature, general weakness. Chronic phlebitis of superficial veins is characterized by a smoothed clinical picture, a recurrent course with periodic exacerbations.
In acute deep vein phlebitis, there is general hyperthermia, pain and swelling in the area of inflammation. The skin of the affected limb becomes milky white. There is no compaction and redness of the skin. In the vast majority of cases, acute deep vein phlebitis is complicated by the formation of blood clots and turns into acute thrombophlebitis.
Cerebral form is manifested by headache, increased blood pressure, neurological symptoms. With phlebitis of the penis, sharp pains appear, the penis becomes cyanotic, swells. Pileflebitis (phlebitis of the collar vein) is characterized by a picture of pronounced purulent intoxication. The patient’s condition deteriorates sharply, there is weakness, vomiting, headache, cramping cutting pains in the right hypochondrium, increasing jaundice. Hectic fever develops with torrential sweats and terrific chills. There is a risk of death. In a number of patients, collar vein phlebitis acquires a chronic course and causes the development of hepatic and renal insufficiency.
As a result of phlebitis, thrombophlebitis usually develops. There is a danger of thrombosis of the affected vein. Deep vein thrombophlebitis in the acute period can cause pulmonary embolism, in the long term – the cause of chronic venous insufficiency. With phlebitis, there is a risk of developing infectious complications (abscess, phlegmon).
Patients with suspected phlebitis are advised by vascular surgeons – phlebologists. Instrumental diagnostics is carried out using duplex scanning or ultrasound of the veins of the lower extremities or another area, depending on the localization of the process.
With this disease, complex conservative therapy is carried out. Phlebitis of superficial veins in some cases is treated on an outpatient basis. With phlebitis of other localizations, hospitalization is usually indicated.
The affected limb needs complete rest, an elevated position. The patient is prescribed drugs that improve the nutrition of the wall and reduce the viscosity of the blood. General and local anti-inflammatory treatment, physiotherapy procedures are carried out. After relief of the acute process and exacerbation of chronic phlebitis of the lower extremities, it is recommended to use compression knitwear or elastic bandages.
Preventive measures depend on the localization of phlebitis. It is necessary to strictly observe the rules of intravenous infusions and injections, timely treat pustular diseases, inflammatory processes and minor injuries. Patients with varicose veins of the lower extremities should follow the doctor’s recommendations.
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