Let’s cover the major complications. The medical
complications are phlebitis, varicose eczema, leg ulcers and deep vein thrombosis. Phlebitis. Phlebitis should really be called
Superficial Vein Thrombophlebitis. In this condition, thrombus or clot formation is the
main concern and threat. In Superficial Vein Thrombophlebitis there is thrombus – or clot
– in the superficial vein, and inflammation in the tissue surrounding the vein. Often,
a tubular-shaped lump can be felt which is red, tender and painful. The most frequently
affected vein is the saphenous vein on the inner part of the thigh or calf. It can also
occur in the veins of the arms or neck, usually after intravenous cannulation and drug administration.
The important feature in Superficial Vein Thrombophlebitis is the clot formation rather
than the inflammation. The clot in the superficial vein can extend into the deep veins causing
deep vein thrombosis and possibly pulmonary embolism – a clot in the lungs. The diagnosis
of Superficial Vein Thrombophlebitis is established on clinical signs: that is a painful, tender,
red lump along the course of a superficial vein and on the basis of an ultrasound scan.
Venous Duplex ultrasound should be carried out to confirm the diagnosis as well as to
check for deep vein thrombosis in the affected leg and the opposite leg. That is to say,
both legs should be examined by ultrasound. Superficial Vein Thrombophlebitis has traditionally
been considered a rather trivial condition, with treatment mainly focusing on the relief
of symptoms. However, it is now clear that there is a strong association between Superficial
Vein Thrombophlebitis and deep vein thrombosis as well as pulmonary embolism and experts
agree that blood-thinning medication is often necessary to prevent clot spread. Superficial
Vein Thrombophlebitis can sometimes be confused with cellulitis. These conditions, which can
be hard to distinguish clinically – that is simply by looking at the leg- have very different
treatments. Superficial Vein Thrombophlebitis often requires treatment with blood thinning
medication. If not treated properly, the clot can spread and lead to deep vein thrombosis
or even death. Cellulitis on the other hand is an infection that requires antibiotics.
If cellulitis is not treated properly, the infection can enter the blood stream causing
septicaemia, which also can sometimes be fatal. An ultrasound scan is the only way to confidently
distinguish these 2 important conditions. Varicose Eczema
This is a very confusing term. This condition is a complication of superficial venous reflux.
It can exist in the absence of varicose veins. Furthermore, it is not a skin condition as
the term “varicose eczema” might suggest. In fact, it is a vascular issue and the reaction
of the skin is a response to continued damage to the microcirculation. The skin is actually
being deprived of nutrients and oxygen and the area becomes vulnerable and may ulcerate.
The importance of “varicose eczema” is that it indicates venous reflux or sometimes venous
obstruction and if varicose eczema is neglected it may progress to a leg ulcer. Its presence
is a warning sign that should not be ignored. The condition should be investigated by a
duplex ultrasound scan and then treatment of any reflux. It should not be managed with
creams or stockings alone. Steroid creams in particular should be avoided if possible.
Steroid creams will give very prompt relief of redness and itch and can be used very briefly
if symptoms are very distressing, but if used long term, steroid creams thin the skin and
actually cause deterioration. A leg ulcer then becomes much more likely. Deep Vein Thrombosis.
The association between varicose veins and DVT is now very well established. In 2013,
a study from Germany looked at 83,000 people over a three-year period and it found that
people with varicose veins were approximately 9 times more likely to develop a deep vein
thrombosis. A study from Texas in 2012 showed that people undergoing total hip replacement
were at an increased of DVT if they had varicose veins. Very importantly – the study also showed
that people who had had treatment for their varicose veins and who were undergoing total
hip replacement had the same risk of DVT as people who had never had varicose veins. So
these results dispel any doubt that might remain that varicose veins are indeed a risk
factor for deep vein thrombosis and now there is considerable evidence that this risk is
reduced by successful treatment of the varicose veins. Leg Ulceration
This is a feared complication of venous disease. Approximately 90% of leg ulcers are due to
an abnormality of the veins, and the majority of these are due to superficial venous reflux,
which can be cured. Most leg ulcers will develop in an area of varicose eczema and so, not
only are the majority of leg ulcers treatable and often curable, the majority can be avoided
in the first place.