Last Updated on February 21, 2024 by Nasir Hanif
Phlebitis is the inflammation of the walls of the veins of the superficial venous system. This inflammation can occur both with and without thrombi.
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What is phlebitis, and how is it treated?
Phlebitis is a term used for thrombophlebitis, phlebothrombosis, and varicose phlebitis. But since it leads to confusion, doctors have preferred to talk about venous thrombosis, which is the formation of a blood clot inside the vein. However, the existence of varicose phlebitis must also be distinguished: a more specific term is the inflammation of the veins in a previous varicose vein. Let’s delve in more to find out what is phlebitis and how is it treated?
Difference between Phlebitis and Thrombophlebitis
Phlebitis is caused by inflammation of the vein wall. Likewise, thrombophlebitis is the same process but with the presence of a thrombus. The clinical difference is that when you have phlebitis, the part of the inflamed vein is red, hot, and very painful. And when there is a thrombus, it is very hard and dilated.
80% of the blood circulates through the deep venous system. Those veins inside the muscles are not seen. Movement in the muscles causes these veins to compress and the blood to rise.
15-20% of blood goes through the simple system, which is what you see in which varicose veins occur. A system of valves inside the veins makes the blood go from the distal to the proximal parts and from the superficial to the deep system.
What happens when that system fails?
This happens in a general way because the valves fail, which causes the veins to dilate, and the valves do not close. This makes the blood go like an elevator: down and up. Thus, the veins dilate more and more, and the valves prevent the blood from going from the simple system to the deep system, passing from the deep system to the external system. When this happens, the veins dilate, and varicose veins appear.
In this context, three types of vein disease can occur:
Formation of thrombi in the deep venous system, which the appearance of pulmonary thromboembolism can complicate.
Its most common manifestation is the appearance of varicose veins.
Inflammation with or without thrombi of the veins of the superficial venous system.
The causes that produce venous thrombosis are often unknown. Deep vein thrombosis can occur after surgical interventions, prolonged bed rest, infectious diseases, and tumors; they are more frequent as we age. In the majority, superficial venous thrombosis is produced on previous varicose veins.
Phlebitis can occur in the arms and hands of people admitted due to droppers or when introducing medication into the veins of hospitalized people.
Likewise, deep vein thrombosis can also appear. However, not very frequent after trips in which the same position has been maintained for several hours, as is the well-known economy class syndrome.
Phlebitis and varicose phlebitis are the most frequent complications of chronic venous insufficiency. These can also be triggered after a blow, an insect bite, an infection, or after sclerotherapy treatment to make varicose veins disappear.
The symptoms that can alert the presence of venous thrombosis are varied.
In the case of deep thrombosis, there may not be any particular symptoms. But when they do, it is usual for there to be a sudden increase in the volume of the limb, a sensation of numbness, pain, and inflammation. Often the only present symptom is the appearance of that inflammation in one of the extremities. In the case of phlebitis it can appear.
- Tumefaction that is, the inflammation of the varicose vein and its surroundings
- Cutaneous hypersensitivity to low-intensity stimuli, which means that it is painful to the touch
- There is no infectious component but only inflammatory
In the case of venous insufficiency, and before varicose veins appear, it can be experienced in the legs:
- Edema (increased size) that improves with horizontal rest
These symptoms usually get worse when you spend a lot of time on your feet. And in fact, they are more frequent among those who usually stand for work-related reasons. It often begins with the observation that at the end of the day, the mark of the sock is noticeable since little by little edema is produced and that, over the years, will cause varicose veins to appear.
The most important measures to prevent venous disease are modifying lifestyles, performing physical exercise that favors venous return, and avoiding a sedentary lifestyle and prolonged rest.
Among other recommendations:
- Avoid standing for long periods, especially when it is very hot.
- Avoid sitting for a long time and if you have to, have your legs elevated. It is better to get up and move your muscles.
- Sleep in articulated beds.
- Do not wear very tight clothing.
- Special attention in pregnant women, in which the growth of the fetus produces a compression of the iliac veins.
- Do not wear very flat shoes but with small heels.
- A balanced diet.
In patients who have had a thrombosis and it has resolved or who begin to have symptoms of venous insufficiency, the use of compression stockings is recommended. Its use is also recommended for people who have to stand for a long time or work in very hot places -as is the case with bakers or waiters- especially in summer, to prevent venous insufficiency.
Patients who have already had a thrombosis must insist a lot on all prevention and control measures such as:
- Control the weight with the help of the BMI and assess how it evolves to reduce, especially the abdominal perimeter
- Recommend physical exercise at least three times a week for 45 minutes at a good pace
- Elevation of the lower limbs when lying down
- Avoid nearby heat sources.
- Compression treatment with elastic compression stockings
- Pharmacological treatment with venotonics
Venous thrombosis can be classified according to the areas in which they occur. Rial establishes two types:
Deep vein thrombosis:
They can occur after surgical interventions, prolonged bed rest, infectious diseases, and tumors.
Superficial venous thrombosis:
They usually occur on previous varicose veins. Phlebitis, thrombophlebitis, and varicose phlebitis will be included here. They are more common in women since it is in this sex where there is a greater frequency of varicose veins.
The treatment of venous thrombosis should always include the use of compression stockings to promote venous return. Superficial venous thrombosis should be treated with heparin between 30 and 45 days.
In the case of deep vein thrombosis, treatment with heparin is usually started in subcutaneous injections. The duration of anticoagulation is variable.
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