On Phlebitis and DVT

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What is Phlebitis?

Phlebitis (also called thrombophlebitis) is a condition where there is inflammation in the walls of the veins, most commonly the leg veins, and usually clots form in the walls and valves of the veins. DVT (Deep Venous Thrombosis) is when the veins in the deeper areas of the legs, groins and pelvis are involved with the inflammation.

What are the signs and symptoms of Phlebitis?

The most common is pain along the course or location of the veins involved. If it is the leg veins, there will be pain and tenderness (to touch) in the inner thigh and the inner aspect of the lower leg, when these veins are inflamed. There could also be redness along the same course. Sometimes, in chronic cases, pain might be minimal.

Are these the veins that are bluish and bulging in the legs and on the hands?

These prominent veins in the legs and on the hands, although engorged, are varicosed (with weakened and thinned out walls, and filled with blood), as long as they have no pains and tenderness, do not have Phlebitis. They are merely varicosed, with loose (incompetent) valves and promote pooling of blood in the legs and feet, because the one-way valves are loose and not working well. Pregnant women are prone to develop varicose veins.

What causes Phlebitis?

Thick blood (hypercoagulable) that causes clots to form inside the veins, injury to the veins, and pooling of blood in the veins, especially in the legs, are some of the factors that lead to Phlebitis. Undetected cancer anywhere in the body increases the chances of Phlebitis, or even Deep Venous Thrombosis, where the veins deeper in our legs, groins and pelvis develop blood clots. About 95% of DVT develop in the leg veins by the calf (gastrocnemius) muscles in the lower leg, and about 90% of the blood clots traveling to the lungs are from these leg veins.

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If the Phlebitis becomes worse and lead to DVT, the clots in the deeper veins in the legs, groin and pelvis could dislodge and travel to the lungs (Pulmonary Embolism) and block the Pulmonary Artery (the artery that brings blood to the lungs to be replenished with oxygen), thereby reducing the oxygenation of the blood in the body. The vital organs suffer because of severely diminished oxygen, and patient could go into shock, or even die from Pulmonary Embolus.

Do all Phlebitis develop into DVT and Pulmonary Embolus?

No. Most of the Phlebitis subside with proper medical treatment. Part of the management is quitting cigarettes (they thicken blood and irritate the inner walls of the veins and arteries, among others), drinking 6-8 glasses of water a day, elevation of the feet when sitting, anti-platelet (aspirin) regimen, support hoses when vein varicosity (ugly engorged veins) is moderate to severe. Obviously, you need to consult your physician for the proper diagnosis and care.

What tests are needed to diagnose Phlebitis or DVT?

History and physical examination by a physician are most helpful. Doppler Ultrasound (to evaluate flow signals) is about 95% accurate; Pletysmography (measures speed of filling and emptying of the veins) is also about 95% accurate; and, Venogram (dye injected into the vein to find any blockage), which used to be the gold standard for diagnosis, now relegated to number 3 position.

What are the chronic effects of Phlebitis and DVT?

Recurrent Phlebitis and DVT leads to Stasis ulcers and eventually to Post-Phlebitic Syndrome. Stasis Ulcers are break in the skin, usually by the ankles and lower shin bones that do not want to heal, because of the stagnation or pooling of venous (used-up) blood. The lower leg could have swelling because the ulcerations could get inflamed and even infected. Post-Phlebitic Syndrome is the condition where the lower leg is swollen and enalrged, with Stasis Ulcers (or healed ulcers), where the skin becomes very hard and thick, like an elephant's legs. This is caused by the repeated and chronic vein swelling and clotted veins in the legs.

Is there a way to prevent Varicose Veins and Phlebitis?

Genetics make some people more prone to develop Varicose Veins. For preventive measures, do not smoke, exercise at least 4 times a week, drink enough fluids as

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recommended above, elevate your feet when you get home from work, and consult your physician when you have any health concerns.

Could these bulging veins break open and bleed?

Yes, a very small percentage (less than 10%) of patients with severely engorged veins, especially those in the Post-Phlebitic stage, with Stasis Ulcers, could have veins that get infected, break open and bleed. When continuous bleeding occurs, pressure should be applied to the bleeding site, and the patient rushed to the emergency room. If pressure cannot control the bleeding, sometimes sutures are used to stop it.

What is the treatment for Varicose Veins?

For Varicose Veins alone (without Phlebitis or DVT), conservative management is the choice. Some of the measures for prophylaxis we have mentioned above would apply. If the Varicose Veins are cosmetically objectionable, especially among young ladies, surgical vein stripping and/or Sclerotherapy might be indicated in selected cases. Only your surgeon could make this determination and advise you accordingly, depending on his findings.

©2003Raoul R. Diez, M.A.O.D.