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What is phlebitis, and what’s the best treatment?

Phlebitis - Image



Phlebitis, or inflammation of a vein, is a condition where a leg vein and surrounding tissues have become irritated, red, warm, and tender. In an area of phlebitis, the skin can feel as if there are knots or lumps underneath the skin surface.

Phlebitis can occur in superficial veins (close to the skin surface) or deep veins (in the central portion of the leg). Phlebitis affecting the superficial veins is less concerning than phlebitis affecting the deep veins.

If phlebitis occurs in a superficial vein (ie. close to the skin) the overlying skin will commonly be warm and sensitive to light touch. A common pathway for developing phlebitis is when a clot develops in a varicose vein, just underneath the skin surface.

Symptoms of phlebitis are caused by inflammation, which represents the body’s response to injury or tissue damage.

Phlebitis can be triggered by excessive stretching of the leg veins. This situation is commonly encountered in people with varicose veins, where the veins have become abnormally engorged and dilated.

Another situation where phlebitis can occur is when a blood clot has developed in a vein. The presence of blood clot triggers an inflammatory response, which causes pain and tenderness.

When phlebitis occurs is in conjunction with superficial blood the medical term for this condition is “superficial venous thrombophlebitis,” commonly simply abbreviated as “thrombophlebitis”

When a blood clot occurs in a deep vein the term deep vein thrombosis (DVT) more accurately describes the condition and is the preferred terminology.


When phlebitis affects superficial veins common symptoms include pain, tenderness, reddish skin discoloration, and warmth/heat arising from the skin. The most commonly affected area is the calf, but it’s also common for symptoms to occur just above the ankle or on the thigh.

Symptoms of phlebitis affecting the deep veins include aching pain, throbbing, leg heaviness, and leg swelling. Sometimes deep vein thrombosis can occur without significant pain. In this situation, leg/ankle swelling may be the only sign of a deep vein blood clot.

The severity of symptoms due to phlebitis is variable. Most often symptoms are mild-moderate, but sometimes the pain can be severe. Quite often symptoms start to build up over 24-48 hours. Most people who get phlebitis cannot recall a specific triggering injury or event.


Risk factors for phlebitis include being sedentary for long periods (eg. long plane flight or car ride), obesity, smoking, estrogen-containing medications (including oral contraceptives and hormone replacement therapy), clotting disorders (which may predispose to easy clotting), and externally visible varicose veins. Other risk factors include trauma to a varicose vein (eg. if your leg bumps against the dishwasher), and cancer (which can increase the risk of developing blood clots).


Several medical conditions mimic phlebitis. Probably the most common condition that mimics phlebitis is cellulitis, a bacterial infection of the skin. Several other dermatologic and auto-immune conditions can mimic phlebitis.


The diagnosis of phlebitis is based on symptoms and examination findings, supplemented by diagnostic imaging. The most common imaging study used to support the diagnosis of phlebitis is venous ultrasound.


The optimal treatment of phlebitis varies on several factors. If phlebitis is localized to a small section of a superficial vein then warm compresses, oral anti-inflammatory medications (eg. Motrin), topical anti-inflammatory creams (eg. Arnica), and leg elevation may be all that’s required.

If you have a superficial clot (superficial thrombophlebitis) that’s close to a connection with a deep vein, you may require blood thinners.

If a blood clot is identified in a deep vein (deep vein thrombosis – DVT) you’ll likely need to start on a blood-thinner, unless there’s a contraindication.

If you think you might have phlebitis, it’s important to seek medical attention. You’ll probably need a vein ultrasound to diagnose what’s going on.  Other management recommendations will be guided by the assessment of your medical provider.


A high percentage of patients with superficial phlebitis have an associated condition known as venous reflux. This is a condition where the valves in the leg veins have ceased to function effectively. If venous reflux is present procedures can be performed to treat the underlying problem.

Commonly performed vein procedures include such as radiofrequency ablation (ClosureFast procedure), VenaSeal closure system, Varithena microfoam, Clarivein, and endovenous laser therapy (EVLT). These procedures seal closed the bad veins that creating the environment in which superficial phlebitis can occur. Vein procedures are usually performed in a staged fashion after the flare-up of superficial phlebitis has abated.

Vascular Solutions is the leading vein clinic for varicose veins treatment in Charlotte, NC. We use the latest technology and get the best results. Our vein specialists are the best in the Carolinas. If you believe you have phlebitis contact our office now to set up your new patient consultation.



Peter Ford MD FACS RPVI Peter Ford, MD, FACS, RPVI, is a board certified vascular surgeon who works at Vascular Solutions in Charlotte, North Carolina. Dr. Ford specializes in the management of varicose veins and venous disease.

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