Member Case Study: Superficial Thrombophlebitis

author : AMSSM

comments : 0

Would getting the veins fixed have any potential triathlon performance implications? Is there anything else I should be doing for them when I swim/bike/run?

Member Question from Micawber 

I went to a clinic and saw a doctor about the pains in my left leg for most of the last week. He didn't use the medical terms but I looked up what he described and found "superficial thrombophlebitis". That's inflammation and irritation from blood clotting in the leg, but in some surface veins - not the dangerous deep vein kind. I just happen to have it in a large system of varicose veins that developed from an old injury.

He said it should clear up on it's own soon; it's just painful for now. I also asked about exercising and he said that it really didn't matter one way or the other, so I guess I can continue if I can put up with the discomfort? He did suggest a few things, like a warm cloth, aspirin, etc. He also said that I might consider getting the varicose veins fixed as the surface veins aren't really necessary anyway.

Would getting the veins fixed have any potential triathlon performance implications? Is there anything else I should be doing for them when I swim/bike/run?  I've also wondered about using some of the compression gear that's becoming popular but the biggest patch of varicose veins is on my lower, inner left thigh so it would take a full pair of tights to cover it and I haven't tried that yet.
 

Answer from Thad Barkdull, MAJ, MC

Member AMSSM

Let me make sure that I have all of your questions:

1. Would getting the veins fixed have any potential triathlon performance implications?

a. Removal or “stripping” of the varicose veins will not have any long term complications with performing in sports like triathlons. The body is excellent at using alternate or “collateral” blood flow to return blood to the heart (the function of the veins). There is controversy over whether treatment of the varicose veins, in the long run, reduces the risk of getting superficial thrombophlebitis.

If this is your first episode of the condition, I’m not sure that I would be that aggressive at going for a surgical intervention. However, if you’ve had repeated episodes, this may be something worth discussing with a vascular surgeon. There are also some newer techniques such as endovenous catheter ablation (basically cauterizing the vein closed with an electric impulse), which may be as equally successful with quicker return time. However, about 20% of patients receiving surgery have recurrence of the varicosities, so it’s not perfect.

2. Is there anything else I should be doing for them when I swim/bike/run?

a. I would consider using some compression stockings when running/biking. You can purchase these at most medical equipment facilities. These often reduce the pain associated with the condition. However, if a lot of your pain is up in your thigh, it might be difficult to find a compression stocking that will have the desired effect that high. My experience is that they work great below the knee, and the effectiveness diminishes the further up you go. But they are worth a try.

b. Superficial thrombophlebitis should resolve in 6-8 weeks. The treatment of the phlebitis can include non-steroidal anti-inflammatories (NSAIDs) like ibuprofen or naproxen, elevation, and compression stockings. Usually the symptoms are for the most part resolved by about a week. If they’re not, you should consider having your doctor check for other conditions, like skin infection (cellulitis), or some unusual inflammatory disorders, such as polyarteritis nodosa. Additionally, some superficial clots can extend into the deep veins. When they are below the knee, the likelihood of a piece of the clot, or embolus, coming off and going to the lungs (a potentially life-threatening condition called pulmonary embolus) is small. However, when above the knee, most physicians advocate using “blood thinner” medications to reduce the risk of any emboli making their way to the lungs.

Finally, as I mentioned before, the symptoms usually resolve over days to weeks. If this is persisting, I would consider having your physician consider other possible causes of your pain. Infections, inflammatory diseases, and other vascular insufficiencies can cause these symptoms. Because of the location, if the symptoms persist, I would strongly advocate getting a compression ultrasound to ensure that there are no deep clots that could put you at increased risk for embolus formation. Additionally, this may also be a musculoskeletal injury, and the presence of your varicose veins in the same area may just be a “red herring”.
 

Good luck.

Thad Barkdull, MAJ, MC
Director, Sports Medicine
Family Medicine Department, Tripler Army Medical Center
Honolulu, Hawaii

"He koa na 'alapa a pau" (Every Warrior an Athlete)

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date: March 19, 2009