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Superficial Venous Thrombosis

by James D. Douketis, MD

Superficial venous thrombosis is a blood clot in a superficial vein of the upper or lower extremities or, less commonly, in one or more veins of the chest or breast (Mondor disease).

Superficial venous thrombosis in the upper extremity most commonly results from IV infusions or catheterization; varicose veins seem to be the main risk factor for the lower extremity, especially among women. Superficial venous thrombi rarely cause serious complications and rarely become emboli.

Typically, patients present with pain, tenderness, or an indurated cord along a palpable superficial vein. The overlying skin is usually warm and erythematous. Migratory superficial venous thrombosis, which develops, resolves, and recurs in normal veins of the arms, legs, and torso at various times, is a possible harbinger of pancreatic cancer and other adenocarcinomas (Trousseau syndrome).

Diagnosis is based on history and physical examination. Patients with superficial venous thrombosis above the knee have an increased risk of deep venous thrombosis and should probably have ultrasonography.

Treatment traditionally involves warm compresses and NSAIDs, but local thrombectomy with a local anesthetic is very effective. In patients with extensive superficial phlebitis, heparin is often beneficial.

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