Written by epgonline.org - Last updated 29 May 2018
This category covers a range of thrombotic and embolic conditions relating to different areas of the venous system. Venous thrombosis is unusual in some respects, in that the same pathological process can have vastly different implications for the health of an individual depending on the site.
Superficial phlebitis is inflammation of a vein, and may present as a result of iatrogenic trauma, as a manifestation of a more widespread disease such as systemic lupus erythematosus (SLE), or paraneoplastic syndromes in response to some malignancies. It is often accompanied by thrombosis, and symptomatically can present as pain, swelling or itching along a vein. Phlebitis alone is unlikely to cause any problems, and management is usually symptomatic.
Thrombosis of the deep veins – most commonly in the lower limb, may generate more serious sequelae. Clinically, a red, painful, oedematous limb with tenderness along deep venous structures, and a measurably larger circumference are hallmarks of deep vein thrombosis (DVT). Recent immobilisation and prothrombotic states are risk factors that should be explored as part of the assessment process.
Although not included within this section, pulmonary embolism (PE) is usually a direct consequence of DVT, and epidemiological data typically group the two into venous thromboembolism (VTE). VTE is a common condition, with an incidence of about 1 episode per 1,000 adults annually. This rises significantly with age; in the over 85 age group, a new VTE occurs approximately 7 times per 1,000 adults annually.
Treatment is with anticoagulation, typically for a period of six months for an uncomplicated DVT, although this may vary. PE is the most common serious consequence of a DVT, although abnormal cardiac structure can result in an embolus bypassing the pulmonary circulation and causing an occlusive event elsewhere. An interventional approach can be used to insert an inferior vena cava filter in patients particularly at risk.
Also covered in the phlebitis disease group are rarer venous thrombo-occlusive diseases. These include thrombophlebitis migrans, a paraneoplastic manifestation of hypercoagulopathy, and Budd-Chiari syndrome, thrombotic occlusion of the hepatic veins that typically presents with a triad of pain, ascites and hepatomegaly.
Thrombosis may affect any area of the venous system, from superficial veins, to the portal circulation or the vena cava. It is always worth considering the underlying causative factors when approaching the situation clinically.