Phlebitis
What causes phlebitis? All the information about this condition: causes, symptoms, and treatments.
Symptoms and Causes
Phlebitis refers to the inflammation of the inner layer of the veins. Although it can occur in any vein, it most commonly affects those in the legs, ankles, feet, or arms.
Depending on which veins are affected, two types of phlebitis are distinguished:
Superficial phlebitis: occurs in the superficial veins of the skin. It is a common and benign condition with a good prognosis.
Deep phlebitis: affects the veins beneath the skin. It is less common but can be very serious.
Symptoms
The symptoms of phlebitis vary depending on the type:
Symptoms of superficial phlebitis:
- Erythema: reddening of the skin.
- Swelling of the vein.
- Tenderness and pain in the area, which worsens when pressure is applied.
- Increase in skin temperature, feeling of heat.
- Fever may appear.
Symptoms of deep phlebitis:
- Edema: swelling of the affected area.
- Pale or cyanotic skin.
- Hardening of the vein.
- Dull pain.
- Decreased arterial pulse in the area.
- Tachycardia.
- Venous gangrene may appear: loss of sensation and purple coloring.
Causes
Phlebitis is generally caused by infectious conditions that affect the vein and trigger its inflammation (bacterial phlebitis), such as cellulitis, pneumonia, or endocarditis. It can also be caused by injuries or trauma that damage or irritate the vein (mechanical phlebitis), such as direct blows, burns, surgeries, or catheterizations. Additionally, it can be caused by chemicals introduced into the vein that are irritating (chemical phlebitis), such as very acidic, alkaline, or hypertonic solutions.
Deep phlebitis, known as thrombophlebitis or deep vein thrombosis, originates from the formation of a thrombus or clot in the vein. Clots form due to altered blood flow caused by injury, a clotting disorder, or prolonged immobility.
Risk Factors
Risk factors that increase the likelihood of developing phlebitis include:
- Recent infections.
- Hip, knee, or pelvic surgeries.
- Bone fractures.
- Injuries or wounds to arms and legs.
- Intravenous drug administration.
- Circulatory disorders, such as varicose veins or thrombophilia.
- Obesity.
- Sedentary lifestyle.
- Prolonged periods of immobility in the extremities.
- Smoking.
- Pregnancy and postpartum.
- Use of birth control pills or hormone replacement therapy with estrogens.
- Lymphatic system disorders.
- Cancer.
- Immune system disorders, such as lupus or Behcet's disease.
Complications
Superficial phlebitis is generally not serious. However, deep phlebitis can be dangerous. If the clot causing it detaches, it can travel through the bloodstream to the lungs, block an artery, and cause a pulmonary embolism, which can be fatal. Phlebitis can also lead to post-phlebitic syndrome, a chronic condition caused by increased venous pressure, resulting in skin ulcers and pain that can become debilitating.
Prevention
To prevent phlebitis, measures aimed at improving blood circulation can be taken:
- Maintain a healthy weight.
- Avoid smoking.
- Follow a balanced diet low in salt.
- Exercise regularly.
- Rest with the legs elevated.
- Avoid very high temperatures.
- Drink plenty of water.
- In cases of prolonged inactivity, it is advisable to stand up, walk, or regularly move the limbs.
What doctor treats phlebitis?
Phlebitis is assessed and treated in angiology and vascular surgery units.
Diagnosis
After studying the symptoms and potential risk factors, several tests are performed to determine the type of phlebitis:
- Blood tests: levels of D-dimer are measured. If clots are present, this protein level will be elevated. It is not conclusive, as it can also rise due to other conditions. Infection markers, such as leukocyte levels, C-reactive protein, or erythrocyte sedimentation rate, are also sought.
- Doppler ultrasound: images are taken using ultrasound to visualize blood flow and detect the presence of clots.
- Venography: blood vessels are visualized by injecting a contrast solution during an X-ray exam.
Treatment
Treatment differs depending on whether it is superficial or deep phlebitis:
Superficial phlebitis: the treatment focuses on reducing inflammation.
- Elevate the affected limb to improve blood return.
- Administer anti-inflammatory drugs.
- Apply antiseptic, anti-inflammatory, and heparinoid ointments.
- Use compression stockings.
- Administer antibiotics in case of bacterial phlebitis.
Deep phlebitis: the treatment focuses on dissolving existing clots and preventing the formation of new ones.
- Administer anticoagulants, such as heparin or warfarin.
- Administer antiplatelet agents, such as aspirin.
- Administer thrombolytics: drugs that dissolve clots. These are used only in cases of extremely severe pulmonary embolism due to the very high risk of bleeding.
- Cava vein filter: a temporary device is implanted in the inferior vena cava to prevent clot migration. It is used when the patient cannot receive anticoagulant treatment or if it is ineffective.
- Phlebectomy: a surgical procedure to remove the affected veins.
