诊断步骤
浅静脉血栓性静脉炎的诊断是根据基本的临床症状：浅静脉局部的疼痛、触痛、硬化、皮温升高、红斑和/或沿浅静脉走向的条索。
[Figure caption and citation for the preceding image starts]: 大隐静脉浅静脉血栓性静脉炎Lucia MA, Ely EW. N Engl J Med. 2001:344;1214; 许可后使用 [Citation ends]. However, use of Doppler ultrasonography should be recommended to diagnose concomitant ipsilateral and/or contralateral asymptomatic deep vein thrombosis (DVT), to confirm the clinical diagnosis of SVT, and to show thrombus extension and thrombus head location regarding the saphenofemoral and saphenopopliteal junctions. Doppler ultrasonography may also help in the presence of a difficult differential diagnosis that may include cellulitis, erythema nodosum, and lymphangitis.
病史
Patients with SVT often report the gradual onset of localised pain followed by the appearance of an area of redness along the course of a superficial vein. Some report constitutional symptoms such as low-grade fever; high fever and purulent discharge suggest septic (infected) thrombophlebitis. Moreover, septic thrombophlebitis, which most often occurs as a result of bacterial entry from an intravenous catheter, may be associated with bacteraemia and severe systemic infection that can lead to shock. Symptoms of SVT typically develop over hours to days and resolve in days to weeks. Pigmentation changes of the skin overlying the SVT are often observed. The cord may remain palpable for several weeks to months after an initial episode of SVT. In a patient with varicose veins, there may be history of local trauma. Other known risk factors of SVT should be elicited on history. Strong risk factors include a history of varicose veins, thrombophilic disorders, autoimmune diseases, sclerotherapy, intravenous catheterisation, and a previous history of SVT.
查体
对于已有静脉曲张的患者，体检可触及皮肤下蠕虫状的柔软包块，表面皮肤发红且皮温升高，周围常有水肿，但整个肢体无明显肿胀。没有静脉曲张的患者，常有可触及的条索，有时为结节，伴有皮温升高、触痛以及沿非曲张静脉走行的红斑。红斑和水肿可以延伸到周围皮肤，使其难以与蜂窝织炎鉴别。
此外，探查潜在的深静脉血栓也同样重要，因为炎症的临床体征和症状常常因血栓数厘米深而被隐藏或滞后。[34] The prevalence of concomitant DVT varies widely in the literature from 2.6% to 65%, and, if present, it is thought to be contiguous with SVT in 50% to 75% of cases. The thrombus extends by contiguity to the deep venous system through the saphenofemoral or saphenopopliteal junctions, or, less commonly, through the perforating veins.[35] 更重要的是要注意，多达 25% 的伴随的深静脉血栓与SVT可能不是连续的，可能发生在对侧肢体。[36] 深静脉血栓不连续时，深静脉血栓形成的发生机制可能与高凝状态有关。
Concomitant pulmonary embolism (PE) can also occur in anywhere between 0.5% to 4% of patients with SVT and symptoms of PE. Hence it is important to elicit history for PE symptoms such as dyspnoea, chest pain, and syncope.
感染性SVT通常是静脉腔内操作或置管引起的，可出现高热，注射或置管部位流脓、淋巴管炎。
若病史和/或查体怀疑患者存在动脉功能不全，则应在使用弹力袜之前评估踝臂压力指数。
多普勒超声检查
SVT 的诊断大多数依靠病史和查体。然而，临床检查并不总能真实的反映出 SVT 的程度，手术探查经常显示出血栓范围要比临床估计的大5~10 cm。[37] 事实上，系统性多普勒超声的应用发现许多SVT患者伴有深静脉血栓（5.6%~36%）。[15][38][39][40][41][42] 此概率变化范围大可以用各研究对深静脉血栓的定义不同（例如，近端或远端、是否累及肌静脉）来解释。同样地，新的观点认为许多临床诊断为下肢 SVT 的患者，仍可通过行双下肢血管超声明确 SVT 诊断同时排除同侧和/或对侧深静脉血栓而获益。
对于有其他深静脉血栓风险（例如恶性肿瘤、妊娠）或整个下肢水肿或 SVT 位于膝盖以上的患者，多普勒超声是非常重要的。多项研究表明，对于 SVT 出现在大隐静脉近端或隐股静脉连接处的患者，深静脉血栓形成的风险更高。[43][44][45] 此外，一些因素被视为深静脉血栓的预测因素，例如性别、深静脉血栓病史、出现症状到明确诊断间隔期短、严重的慢性静脉功能不全。[46] Other factors, such as greater saphenous vein SVT, bilateral SVT, age >60 years, and bed rest have been suggested as high-risk factors for underlying DVT but not confirmed.
SVT仅位于膝盖下、伴静脉曲张且无静脉血栓栓塞危险因素的患者可能不需要多普勒超声评估，但尚无确切实验证实。
进一步检查
完成多普勒超声评估后，可行进一步检查。当 SVT 患者伴有静脉曲张或 SVT 病因明确时（例如静脉置管、硬化治疗、口服避孕药），可无需进一步检查。但仍需要临床随访并复查多普勒超声，以确认血栓有无增多，特别是在缺少有效的保守治疗或发展成整个腿部水肿时。
若 SVT 反复发作和/或迁移或怀疑结节性多动脉炎等炎症性疾病时，应该进行活检。最好采用横向于静脉长轴的椭圆形切口而不是穿刺活检。浅表真皮的小血管不受累是典型表现。[47]
In patients with suspected SVT with concomitant respiratory symptoms or signs of PE (chest pain, dyspnoea, syncope), pulmonary CT angiography or a ventilation perfusion scan to look for concomitant PE should be performed. If both tests are non-conclusive and PE is still suspected, then a conventional pulmonary angiogram is indicated.
对潜在静脉血栓栓塞风险的评估包括对易栓症的筛查和对潜在恶性肿瘤的评估。在以下患者中推荐：
Above-knee SVT
位于短静脉段的 SVT 而没有静脉曲张
多普勒超声检查显示广泛的隐静脉血栓性静脉炎，伴或不伴深静脉血栓或肺动脉栓塞。
反复发作的 SVT
特发性SVT。
It should be noted, however, that the utility and cost-effectiveness of screening for thrombophilic states in patients with SVT has not been well studied. Thrombophilia screening includes testing for the presence of factor V Leiden and prothrombin G202010A genetic variants; deficiencies of protein S, C, and antithrombin III; positive lupus anticoagulant and anticardiolipin antibodies; and hyperhomocysteinaemia.
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