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 (DVT) and should probably have ultrasonography.
Treatment traditionally involves warm compresses and NSAIDs.
In patients with extensive superficial venous thrombosis, anticoagulation (eg, with low molecular weight heparin, fondaparinux) is often beneficial. The optimal regimen and duration are unknown, but most experts recommend using either low molecular weight heparin (eg, enoxaparin 40 mg subcutaneously once a day or fondaparinux 2.5 mg subcutaneously once a day) and treating for about 1 month.
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