[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Superficial thrombophlebitis (superficial vein thrombosis)

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# Superficial thrombophlebitis (superficial vein thrombosis)

A clot with inflammation in a vein just under the [skin](https://durgical.com/en/anatomy/skin/), felt as a hard, red, painful cord. It is usually mild but can spread into deep veins.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Great saphenous vein](https://durgical.com/en/anatomy/great-saphenous-vein/)
- [Small saphenous vein](https://durgical.com/en/anatomy/small-saphenous-vein/)
- [Femoral vein](https://durgical.com/en/anatomy/femoral-vein/)
- [Popliteal vein](https://durgical.com/en/anatomy/popliteal-vein/)
- [Perforating veins](https://durgical.com/en/anatomy/perforating-veins/)
- [Leg veins](https://durgical.com/en/anatomy/anterior-tibial-veins/)
- [External iliac vein](https://durgical.com/en/anatomy/external-iliac-vein/)
- [Skin](https://durgical.com/en/anatomy/skin/)

## Why it happens

- [Thrombosis and Virchow's triad](https://durgical.com/en/general-pathology/thrombosis-and-virchow-s-triad/)
- [Arterial vs venous thrombi; mural thrombi and lines of Zahn](https://durgical.com/en/general-pathology/arterial-vs-venous-thrombi-mural-thrombi-and-lines-of-zahn/)
- [Blood vessels: artery, vein and capillary layers](https://durgical.com/en/histology/blood-vessels-artery-vein-and-capillary-layers/)

## What it is

Thrombosis with inflammation of a superficial vein, most often the great or [small saphenous vein](https://durgical.com/en/anatomy/small-saphenous-vein/) or their varicose branches in the leg, or an arm vein used for an intravenous line. It shows as a tender, firm, red cord along the vein. It used to be seen as harmless, but it can coexist with or extend into deep vein thrombosis.

## Who gets it

Common, probably more frequent than deep vein thrombosis. It is most frequent in women, older adults and people with varicose veins; in hospitals, infusion-related phlebitis of the arm is one of the most frequent adverse events of peripheral lines.

## Causes

- Varicose veins (the most common setting in the leg)
- Peripheral intravenous catheters and irritant infusions (arm)
- Local trauma or injection of drugs
- Hypercoagulable states: cancer, pregnancy and postpartum, oestrogen therapy, inherited thrombophilia
- Migratory form (Trousseau syndrome) with visceral adenocarcinoma, especially pancreatic
- Vasculitic or inflammatory disease: Buerger disease, Behçet disease

## Risk factors

- Varicose veins and chronic venous insufficiency
- Previous venous thrombosis
- Immobility, recent surgery or long travel
- Obesity
- Pregnancy, oral contraceptives or hormone therapy
- Active cancer

## Pathophysiology

Virchow's triad applies: slow flow in dilated varicose veins, wall injury from catheters, infusions or trauma, and hypercoagulability. Thrombus forms in a superficial vein and the vein wall and surrounding tissue become inflamed, producing pain, redness and induration. The thrombus can extend along the [great saphenous vein](https://durgical.com/en/anatomy/great-saphenous-vein/) to the saphenofemoral junction or through [perforating veins](https://durgical.com/en/anatomy/perforating-veins/) into the deep system, causing deep vein thrombosis and pulmonary embolism.

## Classification

- By site: [lower limb](https://durgical.com/en/anatomy/region/lower-limb/) (great or small saphenous system) or [upper limb](https://durgical.com/en/anatomy/region/upper-limb/)
- Varicose versus non-varicose vein (non-varicose raises concern for cancer or thrombophilia)
- Infusion-related (sterile or septic/suppurative)
- Migratory thrombophlebitis (Trousseau syndrome)
- Thoracoepigastric veins of the [chest](https://durgical.com/en/anatomy/region/chest/) wall (Mondor disease)

## Symptoms and signs

- Pain and tenderness along a superficial vein
- Firm, cord-like vein that can be felt under the skin
- Redness and warmth of the overlying skin
- Mild local swelling (marked leg swelling suggests deep vein thrombosis)
- Low-grade fever is possible; high fever suggests suppurative phlebitis

## Red flags

- Thrombosis in the thigh near the groin (close to the saphenofemoral junction)
- Whole-leg swelling or calf pain (possible deep vein thrombosis)
- Sudden breathlessness, chest pain or haemoptysis (pulmonary embolism)
- High fever, pus or spreading cellulitis at an intravenous site (septic thrombophlebitis)
- Recurrent episodes in different, non-varicose veins (look for cancer)

## Diagnosis

**Clinical**
Mainly clinical: a tender, red, hard cord along a superficial vein. Measure its extent and its distance from the groin or knee crease, and look for signs of deep vein thrombosis.

**Tests**
Usually none. Blood cultures if septic thrombophlebitis is suspected. With migratory or unexplained thrombophlebitis in non-varicose veins, look for cancer and consider thrombophilia testing.

**Imaging**
Compression duplex ultrasound of the leg is recommended for leg involvement, especially above the knee, to measure thrombus length, its distance from the saphenofemoral junction and to exclude coexisting deep vein thrombosis.

## Differential diagnosis

- Cellulitis
- Deep vein thrombosis
- Lymphangitis
- Erythema nodosum or panniculitis
- Ruptured Baker cyst or muscle strain

## Goal of treatment

Relieve pain and inflammation, prevent extension into the deep veins and pulmonary embolism, and identify an underlying cause when the presentation is atypical.

## Treatment

**Conservative**
Warm compresses, leg elevation, graduated compression stockings and staying active; remove an intravenous catheter if it is the cause.

**Medical**
Topical or oral non-steroidal anti-inflammatory drugs for small, distal thrombi. For a leg thrombus at least about 5 cm long, prophylactic-intensity anticoagulation (fondaparinux, a low-molecular-weight heparin or a direct oral anticoagulant) for about 45 days.

**Acute**
When the thrombus lies within about 3 cm of the saphenofemoral junction or extends into the deep veins, treat as deep vein thrombosis with therapeutic anticoagulation.

**Surgical**
Varicose vein treatment after the acute phase to prevent recurrence; excision and antibiotics for suppurative (septic) thrombophlebitis.

**Follow-up**
Nursing priorities: daily inspection and rotation of peripheral intravenous sites with prompt removal at the first signs of phlebitis, watching for extension, leg swelling or breathlessness, and teaching warning signs of pulmonary embolism.

## Complications

- Extension into deep vein thrombosis
- Pulmonary embolism
- Recurrence
- Septic thrombophlebitis with bacteraemia
- Skin pigmentation and residual hard cord

## Prognosis

Most episodes resolve in a few weeks. A proportion of patients have concurrent or later deep vein thrombosis or pulmonary embolism, which is why extensive or proximal thrombi are treated with anticoagulation. Migratory thrombophlebitis can be the first sign of a hidden cancer.

## Prevention

- Proper insertion, care and timely removal of peripheral intravenous lines
- Treatment of symptomatic varicose veins
- Mobilisation and thromboprophylaxis in at-risk hospitalised patients

## Test yourself

Think of the answer, then tap the question to see it.

## What is the classic finding on examination in superficial thrombophlebitis?

A tender, warm, red, firm cord along a superficial vein.

## When is superficial thrombophlebitis of the great saphenous vein treated like deep vein thrombosis?

When the thrombus is within about 3 cm of the saphenofemoral junction or extends into the deep veins.

## Recurrent migratory thrombophlebitis should prompt a search for which disease?

A hidden visceral adenocarcinoma, classically pancreatic cancer (Trousseau syndrome).

## Which test is used to exclude coexisting deep vein thrombosis in a leg superficial thrombophlebitis?

Compression duplex ultrasound of the leg veins.

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## Related conditions

- [Deep vein thrombosis](https://durgical.com/en/conditions/deep-vein-thrombosis/)
- [Pulmonary embolism](https://durgical.com/en/conditions/pulmonary-embolism/)
- [Varicose veins](https://durgical.com/en/conditions/varicose-veins/)
- [Chronic venous insufficiency](https://durgical.com/en/conditions/chronic-venous-insufficiency/)
- [Cellulitis of the leg](https://durgical.com/en/conditions/cellulitis-of-the-leg/)
- [Pancreatic cancer](https://durgical.com/en/conditions/pancreatic-cancer/)
- [Thromboangiitis obliterans (Buerger disease)](https://durgical.com/en/conditions/thromboangiitis-obliterans/)
- [Behçet disease](https://durgical.com/en/conditions/behcet-disease/)
- [Inherited thrombophilia](https://durgical.com/en/conditions/inherited-thrombophilia/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Superficial Venous Thrombosis - Cardiology - Merck Manual Professional Edition](https://www.merckmanuals.com/professional/cardiovascular-disorders/peripheral-venous-disorders/superficial-venous-thrombosis) (Merck Manual Professional Edition, 2025); [Thrombophlebitis: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/001108.htm) (MedlinePlus (U.S. National Library of Medicine), 2024).

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Source: https://durgical.com/en/conditions/superficial-thrombophlebitis/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/superficial-thrombophlebitis/