Superficial Thrombophlebitis/Bleeding Varicosity

Presentation

A patient may present with focal tenderness, a palpable cord, and mild erythema over the course of a superficial vein. The risk factors for the development of a superficial venous thrombosis (superficial thrombophlebitis [ST]) are similar to those of deep venous thrombosis (DVT) and include smoking, estrogen, prolonged immobility, malignancy, clotting disorders, pregnancy, and recent surgery/trauma. Varicose veins are likely the most significant risk factor, with 88% of cases of ST being associated with varicosities.

Superficial venous thrombosis may broadly be divided into four categories: sterile, traumatic (including from venous cannulation or infusion of irritant drugs), infective, or migratory (recurrent, often due to carcinoma of the pancreas).

The risk of venous thromboembolic events (VTE) from ST is very low overall. About 1.3% of patients experience symptomatic VTE from ST. In about 3.4% of patients there is significant proximal extension of the ST, and about 1.6% of patients will have recurrence of this condition after treatment.

Varicose veins not only predispose to ST but may also bleed spontaneously or after minimal trauma. Patients, who are often upset, present with uncontrollable bleeding streaming from a punctate opening over a varicosity in the lower leg. Several techniques are available to control this bleeding.