Diagnosis and management of phlebitis and thrombosis of the superficial veins

GSV: great saphenous vein; AASV: anterior accessory saphenous vein; SSV: small saphenous vein; DVT: deep venous thrombosis; SFJ: saphenofemoral junction; SPJ: saphenopopliteal junction; NSAIDs: nonsteroidal anti-inflammatory drugs.
* Symptomatic care consists of NSAIDs, compression therapy, and topical agents. For patients who have been anticoagulated, nonsteroidal anti-inflammatory agents can be discontinued if there is a concern for bleeding.
¶ Evaluation for hypercoagulability or occult malignancy may be indicated.
Δ For the GSV in the thigh, the clinical examination is less accurate and even more so in patients with obesity. The GSV may be several centimeters below the surface of the skin. Ultrasound examination should be obtained for any uncertainties. Some clinicians favor ultrasound for any patient with suspected axial vein thrombosis (ie, GSV, AASV, SSV).
◊ On ultrasound, the deep veins and the entire course of the axial veins (ie, GSV, SSV, AASV) should be evaluated, as well as any branch varicosities with overlying erythema.
§ The management of thrombus identified within a perforating vein is uncertain. We favor anticoagulation; either therapeutic or prophylactic is reasonable.