FAMILY MEDICINE® COLUMN

By John C. Wolf, D.O.Associate Professor of Family Medicine Ohio University College of Osteopathic Medicine

DEEP VEIN PHLEBITIS CAN BE DEADLY, NEEDS PROMPT EVALUATION

Question: My mother is 67 years old and has diabetes and other health problems. Her legs are very swollen, hot and painful. Would you explain phlebitis and why it is painful?

Answer: Phlebitis, which is also called thrombophlebitis, is the inflammation of a vein and should not be confused with inflammation of an artery. The condition can be divided into two broad categories based upon the vein or veins that are involved -- superficial and deep. Superficial veins are those that run close to the skin while deep veins are those that are within muscles.

Leg swelling can result from phlebitis of either the superficial or deep veins, so I'll start by explaining the superficial variety first. Superficial veins, usually those of the arms or legs, can become inflamed from injury. The most common causes of this are trauma from an accident or from medical treatments such as receiving an IV or an injection of medicine into the vein. If you develop this type of phlebitis, the first thing you'll probably notice is a red and swollen area over the vein. Later, a blood clot will form within the vein and, thereby, block the flow of blood. This causes some additional swelling and pain at the site of the phlebitis.

Though superficial phlebitis is painful, it isn't a life threatening condition because there are many other superficial veins that can assume the work of the damaged one. Also, the risk of the blood clot breaking loose and causing serious problems is quite small.

Superficial phlebitis is treated by elevating the involved limb, providing heat over the affected area, and supplying compression to decrease swelling. Also, rest and the use of aspirin, indomethacin or other antiinflammatory drugs are often part of the therapy. The most intense discomfort usually subsides in a few days, but total healing can take months. Rarely, the vein(s) never return to a completely "normal" state.

Now, let's look at phlebitis of the deep veins, also called deep vein thrombosis. This condition usually involves one or both legs, and there are several things that can increase its likelihood. These "predisposing factors" include: prolonged inactivity such as sitting during a long trip or being bedridden, recent surgery (particularly involving the abdomen, hip, or heart), some types of cancer, and even hormone therapy such as estrogen replacement or birth control pills. Also, pregnancy and delivery, obesity, and blood disorders like polycythemia can increase your risk.

Thrombophlebitis of a deep vein is a serious condition because there are fewer deep veins to take up the work of the blocked one. This causes swelling of the leg. The greatest risk, however, is that part of the blood clot will break loose and be carried to the lungs were it causes a pulmonary embolism -- a serious and potentially fatal blockage of circulation to the lungs. Consequently, any unexplained leg swelling or swelling with associated leg pain should be evaluated by a physician to determine if it's caused by phlebitis, and if so, whether the problem is with superficial or deep veins.

Deep vein phlebitis is treated with powerful anticoagulants that are commonly called "blood thinners." This is usually started in the hospital and then continues with oral medicine for months or perhaps for life. IV medicine to dissolve the blood clot or surgery to remove it is also of benefit for some. In other situation a filter is placed with the large vein of the lower part of the body, called the vein cava, to filter out any clots that do break loose. After the acute episode is under control, it is usually necessary to wear support stocking to limit leg swelling.

I can't tell you why your mother has leg swelling, but I can tell you that it is important for her to promptly see her physician to determine
if she has phlebitis.

"Family Medicine" is a weekly column.

To submit questions, write to John C. Wolf, D.O., at Post Office Box 110, Athens, Ohio 45701.

Past columns are available online at http://www.FamilyMedicineNews.org.