Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Phlebitis and thrombosis of the superficial lower extremity veins

Sherry Scovell, MD, FACS
Section Editors
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Phlebitis and thrombosis of the lower extremity superficial veins (ie, superficial thrombophlebitis) is generally a benign, self-limited disorder; however, when the larger axial veins are involved (ie, superficial vein thrombosis [SVT]), propagation into the deep vein system (ie, deep vein thrombosis [DVT]) and even pulmonary embolism can occur [1,2]. Treatment is aimed at relieving local symptoms and preventing thromboembolic complications.

The clinical manifestations, diagnosis, and treatment of phlebitis and thrombosis of the lower extremity superficial veins are reviewed here. Phlebitis and thrombosis involving upper extremity veins most often occurs in the context of upper extremity venous cannulation, and is discussed separately. Evaluation and treatment of patients with DVT are discussed separately. (See "Catheter-related upper extremity venous thrombosis" and "Clinical presentation and diagnosis of the nonpregnant adult with suspected deep vein thrombosis of the lower extremity" and "Overview of the treatment of lower extremity deep vein thrombosis (DVT)".)


The term phlebitis refers to the presence of inflammation within a vein, whereas thrombosis indicates the presence of clot within the vein [3]. The veins of the lower extremity are given in the vein list (table 1) and depicted in the figures (figure 1A-B).

A source of ongoing confusion is the persistent use of the abandoned term "superficial" femoral vein to describe the main deep vein in the thigh, properly called the femoral vein, which is adjacent to the superficial femoral artery (figure 2) [4,5]. A need for a change in terminology was recognized when it became apparent that a majority of primary care physicians would not have treated a patient with a "superficial" femoral vein thrombosis with anticoagulation [4]. (See "Classification of lower extremity chronic venous disorders", section on 'Anatomy (The "A" component of CEAP)'.)

In this review we will refer to the terminology surrounding this condition in the following manner:

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: May 18, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Decousus H, Quéré I, Presles E, et al. Superficial venous thrombosis and venous thromboembolism: a large, prospective epidemiologic study. Ann Intern Med 2010; 152:218.
  2. Di Nisio M, Wichers IM, Middeldorp S. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev 2013; :CD004982.
  3. Milio G, Siragusa S, Minà C, et al. Superficial venous thrombosis: prevalence of common genetic risk factors and their role on spreading to deep veins. Thromb Res 2008; 123:194.
  4. Bundens WP, Bergan JJ, Halasz NA, et al. The superficial femoral vein. A potentially lethal misnomer. JAMA 1995; 274:1296.
  5. Caggiati A, Bergan JJ, Gloviczki P, et al. Nomenclature of the veins of the lower limbs: an international interdisciplinary consensus statement. J Vasc Surg 2002; 36:416.
  6. Meissner MH, Wakefield TW, Ascher E, et al. Acute venous disease: venous thrombosis and venous trauma. J Vasc Surg 2007; 46 Suppl S:25S.
  7. Leon L, Giannoukas AD, Dodd D, et al. Clinical significance of superficial vein thrombosis. Eur J Vasc Endovasc Surg 2005; 29:10.
  8. Decousus H, Leizorovicz A. Superficial thrombophlebitis of the legs: still a lot to learn. J Thromb Haemost 2005; 3:1149.
  9. Cannegieter SC, Horváth-Puhó E, Schmidt M, et al. Risk of venous and arterial thrombotic events in patients diagnosed with superficial vein thrombosis: a nationwide cohort study. Blood 2015; 125:229.
  10. Lind C, Flinterman LE, Enga KF, et al. Impact of incident venous thromboembolism on risk of arterial thrombotic diseases. Circulation 2014; 129:855.
  11. Guex JJ. Thrombotic complications of varicose veins. A literature review of the role of superficial venous thrombosis. Dermatol Surg 1996; 22:378.
  12. Samlaska CP, James WD. Superficial thrombophlebitis. II. Secondary hypercoagulable states. J Am Acad Dermatol 1990; 23:1.
  13. Gillet JL, Allaert FA, Perrin M. [Superficial thrombophlebitis in non varicose veins of the lower limbs. A prospective analysis in 42 patients]. J Mal Vasc 2004; 29:263.
  14. De Maeseneer MG, Thrombosis Guidelines Group of the Belgian on, Thrombosis and Haemostasis, Belgian Working Group on Angiology. Superficial thrombophlebitis of the lower limb: practical recommendations for diagnosis and treatment. Acta Chir Belg 2005; 105:145.
  15. McColl MD, Ramsay JE, Tait RC, et al. Risk factors for pregnancy associated venous thromboembolism. Thromb Haemost 1997; 78:1183.
  16. van Langevelde K, Lijfering WM, Rosendaal FR, Cannegieter SC. Increased risk of venous thrombosis in persons with clinically diagnosed superficial vein thrombosis: results from the MEGA study. Blood 2011; 118:4239.
  17. Cortelezzi A, Moia M, Falanga A, et al. Incidence of thrombotic complications in patients with haematological malignancies with central venous catheters: a prospective multicentre study. Br J Haematol 2005; 129:811.
  18. Diaconu C, Mateescu D, Bălăceanu A, et al. Pancreatic cancer presenting with paraneoplastic thrombophlebitis--case report. J Med Life 2010; 3:96.
  19. Varki A. Trousseau's syndrome: multiple definitions and multiple mechanisms. Blood 2007; 110:1723.
  20. Kesteven P, Robinson B. Superficial thrombophlebitis followed by pulmonary embolism. J R Soc Med 2001; 94:186.
  21. Blumenberg RM, Barton E, Gelfand ML, et al. Occult deep venous thrombosis complicating superficial thrombophlebitis. J Vasc Surg 1998; 27:338.
  22. Binder B, Lackner HK, Salmhofer W, et al. Association between superficial vein thrombosis and deep vein thrombosis of the lower extremities. Arch Dermatol 2009; 145:753.
  23. Bounameaux H, Reber-Wasem MA. Superficial thrombophlebitis and deep vein thrombosis. A controversial association. Arch Intern Med 1997; 157:1822.
  24. Lutter KS, Kerr TM, Roedersheimer LR, et al. Superficial thrombophlebitis diagnosed by duplex scanning. Surgery 1991; 110:42.
  25. Bergqvist D, Jaroszewski H. Deep vein thrombosis in patients with superficial thrombophlebitis of the leg. Br Med J (Clin Res Ed) 1986; 292:658.
  26. Sarnarna, MM. Haematologica 2003; 123:194.
  27. Superficial Thrombophlebitis Treated By Enoxaparin Study Group. A pilot randomized double-blind comparison of a low-molecular-weight heparin, a nonsteroidal anti-inflammatory agent, and placebo in the treatment of superficial vein thrombosis. Arch Intern Med 2003; 163:1657.
  28. Gorty S, Patton-Adkins J, DaLanno M, et al. Superficial venous thrombosis of the lower extremities: analysis of risk factors, and recurrence and role of anticoagulation. Vasc Med 2004; 9:1.
  29. Lohr JM, McDevitt DT, Lutter KS, et al. Operative management of greater saphenous thrombophlebitis involving the saphenofemoral junction. Am J Surg 1992; 164:269.
  30. Ascer E, Lorensen E, Pollina RM, Gennaro M. Preliminary results of a nonoperative approach to saphenofemoral junction thrombophlebitis. J Vasc Surg 1995; 22:616.
  31. Wichers IM, Di Nisio M, Büller HR, Middeldorp S. Treatment of superficial vein thrombosis to prevent deep vein thrombosis and pulmonary embolism: a systematic review. Haematologica 2005; 90:672.
  32. Quéré I, Leizorovicz A, Galanaud JP, et al. Superficial venous thrombosis and compression ultrasound imaging. J Vasc Surg 2012; 56:1032.
  33. Ellis MH, Fajer S. A current approach to superficial vein thrombosis. Eur J Haematol 2013; 90:85.
  34. American College of Cardiology Foundation Appropriate Use Criteria Task Force, American College of Radiology, American Institute of Ultrasound in Medicine, et al. ACCF/ACR/AIUM/ASE/IAC/SCAI/SCVS/SIR/SVM/SVS/SVU 2013 appropriate use criteria for peripheral vascular ultrasound and physiological testing. Part II: Testing for venous disease and evaluation of hemodialysis access. Vasc Med 2013; 18:215.
  35. Bernardi E, Camporese G, Büller HR, et al. Serial 2-point ultrasonography plus D-dimer vs whole-leg color-coded Doppler ultrasonography for diagnosing suspected symptomatic deep vein thrombosis: a randomized controlled trial. JAMA 2008; 300:1653.
  36. Johnson SA, Stevens SM, Woller SC, et al. Risk of deep vein thrombosis following a single negative whole-leg compression ultrasound: a systematic review and meta-analysis. JAMA 2010; 303:438.
  37. Hanson JN, Ascher E, DePippo P, et al. Saphenous vein thrombophlebitis (SVT): a deceptively benign disease. J Vasc Surg 1998; 27:677.
  38. Messmore HL, Bishop M, Wehrmacher WH. Acute venous thrombosis. Therapeutic choices for superficial and deep veins. Postgrad Med 1991; 89:73.
  39. Skillman JJ, Kent KC, Porter DH, Kim D. Simultaneous occurrence of superficial and deep thrombophlebitis in the lower extremity. J Vasc Surg 1990; 11:818.
  40. Chengelis DL, Bendick PJ, Glover JL, et al. Progression of superficial venous thrombosis to deep vein thrombosis. J Vasc Surg 1996; 24:745.
  41. Verlato F, Zucchetta P, Prandoni P, et al. An unexpectedly high rate of pulmonary embolism in patients with superficial thrombophlebitis of the thigh. J Vasc Surg 1999; 30:1113.
  42. Mozes G, Kalra M, Carmo M, et al. Extension of saphenous thrombus into the femoral vein: a potential complication of new endovenous ablation techniques. J Vasc Surg 2005; 41:130.
  43. Fassiadis N, Kianifard B, Holdstock JM, Whiteley MS. Ultrasound changes at the saphenofemoral junction and in the long saphenous vein during the first year after VNUS closure. Int Angiol 2002; 21:272.
  44. Quenet S, Laroche JP, Bertoletti L, et al. Value of a planned compression ultrasonography after an isolated superficial vein thrombosis: results from a prospective multicentre study. Eur J Vasc Endovasc Surg 2012; 43:233.
  45. Wichers IM, Haighton M, Büller HR, Middeldorp S. A retrospective analysis of patients treated for superficial vein thrombosis. Neth J Med 2008; 66:423.
  46. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest 2016; 149:315.
  47. Skillman, JJ. Superficial phlebitis: Inflammatory, infectious associated with deep vein thrombosis. In: Decision Making in Vascular Surgery, Cronenwett, JL, Rutherford, RB (Eds), WB Saunders, New York 2001.
  48. Decousus H, Prandoni P, Mismetti P, et al. Fondaparinux for the treatment of superficial-vein thrombosis in the legs. N Engl J Med 2010; 363:1222.
  49. Belcaro G. Evolution of superficial vein thrombosis treated with defibrotide: comparison with low dose subcutaneous heparin. Int J Tissue React 1990; 12:319.
  50. Belcaro G, Nicolaides AN, Errichi BM, et al. Superficial thrombophlebitis of the legs: a randomized, controlled, follow-up study. Angiology 1999; 50:523.
  51. Ferrari E, Pratesi C, Scaricabarozzi I. A comparison of nimesulide and diclofenac in the treatment of acute superficial thrombophlebitis. Drugs 1993; 46 Suppl 1:197.
  52. Seccia M, Bortolotti P, Bellomini MG, et al. [Use of defibrotide in the treatment of acute superficial thrombophlebitis of the legs]. Minerva Chir 1989; 44:1379.
  53. Becherucci A, Bagilet D, Marenghini J, et al. [Effect of topical and oral diclofenac on superficial thrombophlebitis caused by intravenous infusion]. Med Clin (Barc) 2000; 114:371.
  54. Agus GB, de Angelis R, Mondani P, Moia R. Double-blind comparison of nimesulide and diclofenac in the treatment of superficial thrombophlebitis with telethermographic assessment. Drugs 1993; 46 Suppl 1:200.
  55. www.fda.gov/downloads/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/UCM193101.pdf (Accessed on March 12, 2009).
  56. Bergqvist D, Brunkwall J, Jensen N, Persson NH. Treatment of superficial thrombophlebitis. A comparative trial between placebo, Hirudoid cream and piroxicam gel. Ann Chir Gynaecol 1990; 79:92.
  57. Vilardell M, Sabat D, Arnaiz JA, et al. Topical heparin for the treatment of acute superficial phlebitis secondary to indwelling intravenous catheter. A double-blind, randomized, placebo-controlled trial. Eur J Clin Pharmacol 1999; 54:917.
  58. Nocker W, Diebschlag W, Lehmacher W . The efficacy of a diclofenac gel compared with placebo and heparin gel in the local treatment of superficial thrombophlebitis. Zeitschrift fur Allegemein-Medizin 1991; 67:2214.
  59. Boehler K, Kittler H, Stolkovich S, Tzaneva S. Therapeutic effect of compression stockings versus no compression on isolated superficial vein thrombosis of the legs: a randomized clinical trial. Eur J Vasc Endovasc Surg 2014; 48:465.
  60. Lozano FS, Almazan A. Low-molecular-weight heparin versus saphenofemoral disconnection for the treatment of above-knee greater saphenous thrombophlebitis: a prospective study. Vasc Endovascular Surg 2003; 37:415.
  61. Galanaud JP, Bosson JL, Genty C, et al. Superficial vein thrombosis and recurrent venous thromboembolism: a pooled analysis of two observational studies. J Thromb Haemost 2012; 10:1004.
  62. Titon JP, Auger D, Grange P, et al. [Therapeutic management of superficial venous thrombosis with calcium nadroparin. Dosage testing and comparison with a non-steroidal anti-inflammatory agent]. Ann Cardiol Angeiol (Paris) 1994; 43:160.
  63. Prandoni P, Tormene D, Pesavento R, Vesalio Investigators Group. High vs. low doses of low-molecular-weight heparin for the treatment of superficial vein thrombosis of the legs: a double-blind, randomized trial. J Thromb Haemost 2005; 3:1152.
  64. Marchiori A, Verlato F, Sabbion P, et al. High versus low doses of unfractionated heparin for the treatment of superficial thrombophlebitis of the leg. A prospective, controlled, randomized study. Haematologica 2002; 87:523.
  65. Andreozzi GM, Signorelli S, Di Pino L, et al. Tolerability and clinical efficacy of desmin in the treatment of superficial thrombovaricophlebitis. Angiology 1996; 47:887.
  66. Leizorovicz A, Becker F, Buchmüller A, et al. Clinical relevance of symptomatic superficial-vein thrombosis extension: lessons from the CALISTO study. Blood 2013; 122:1724.
  67. Blondon M, Righini M, Bounameaux H, Veenstra DL. Fondaparinux for isolated superficial vein thrombosis of the legs: a cost-effectiveness analysis. Chest 2012; 141:321.
  68. Cosmi B, Filippini M, Tonti D, et al. A randomized double-blind study of low-molecular-weight heparin (parnaparin) for superficial vein thrombosis: STEFLUX (Superficial ThromboEmbolism and Fluxum). J Thromb Haemost 2012; 10:1026.
  69. Kakkos SK, Kirkilesis GI, Tsolakis IA. Editor's Choice - efficacy and safety of the new oral anticoagulants dabigatran, rivaroxaban, apixaban, and edoxaban in the treatment and secondary prevention of venous thromboembolism: a systematic review and meta-analysis of phase III trials. Eur J Vasc Endovasc Surg 2014; 48:565.
  70. Neher JO, Safranek S, Greenwald JL. Clinical inquiries. What is the best therapy for superficial thrombophlebitis? J Fam Pract 2004; 53:583.
  71. Beyer-Westendorf J, Schellong SM, Gerlach H, et al. Prevention of thromboembolic complications in patients with superficial-vein thrombosis given rivaroxaban or fondaparinux: the open-label, randomised, non-inferiority SURPRISE phase 3b trial. Lancet Haematol 2017; 4:e105.
  72. Sullivan V, Denk PM, Sonnad SS, et al. Ligation versus anticoagulation: treatment of above-knee superficial thrombophlebitis not involving the deep venous system. J Am Coll Surg 2001; 193:556.
  73. Lofgren EP, Lofgren KA. The surgical treatment of superficial thrombophlebitis. Surgery 1981; 90:49.
  74. Davidović L, Kostić D, Lotina S, Cinara I. [Indications for surgical treatment of acute superficial thrombophlebitis]. Srp Arh Celok Lek 1990; 118:471.