What is the prognosis of thrombophlebitis?

Updated: Aug 31, 2020
  • Author: Padma Chitnavis, MD; Chief Editor: Dirk M Elston, MD  more...
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Answer

SVT and DVT both have an excellent prognosis if treated promptly. Proper treatment should result in rapid resolution.

After resolution of the acute problem, the following treatment options for the underlying varicose veins should be considered: ambulatory phlebectomy, ligation and stripping, endovenous radiofrequency ablation, and endovenous laser ablation. [97, 98, 99]

DVT causes edema (79.8%), pain (74.6%), and erythema (26.1%), according to a large Italian registry of patients. [90] It may also be associated with the development of life-threatening PE, if untreated. Similarly, superficial thrombophlebitis is not a complication that should be taken lightly. If untreated, the inflammation and clot may spread through the perforating veins to the deep venous system. This extension may lead to valvular damage and possible pulmonary embolic events. [100, 101, 102, 103, 104] Propagation of SVT to DVT may occur in up to 15% of patients. [105] Alarmingly, 10% of SVT either recurs, extends, or progresses to DVT despite treatment. [106] SVT in the presence of an acquired thrombotic risk factor increases the risk of VT by 10- to 100-fold. [107] Superficial thrombophlebitis is associated with an elevated risk of recurrence. [108]

Coincidental DVT with SVT is reportedly more common in patients without varicose veins than in those with varicose veins (60% vs 20%). Thus, other innate factors place patients with SVT at additional risk for DVT.

In a study of 145 patients, superficial thrombophlebitis in 23% of the affected limbs had proximal extension into the saphenofemoral junction (SFJ). [109] PE was found in 7 (33.3%) of 21 patients with thrombophlebitis of the greater saphenous vein (GSV) above the knee. [110] Seventeen of the 21 patients had varicose veins. In this study, clinical symptoms suggestive of PE were present in only 1 of 7 patients. The occurrence of DVT in patients with below-the-knee SVT was 25 (32%) in a study of 78 patients. [111]

A European registry of 4405 patients with acute venous thromboembolism had a 3.1% rate of adverse events in the 3 months following the initial insult. These adverse events included symptomatic PE (0.3%), recurrent DVT (0.4%), major bleeding (0.8%), and death (1.5%). [112]


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