浅表性血栓性静脉炎

Though the diagnosis of superficial vein thrombophlebitis (SVT) is a clinical one, a Doppler ultrasonography examination of at least the affected leg, and ideally the contralateral leg, should be done in all patients with suspected SVT in order to rule out concomitant deep vein thrombosis (DVT) and to assess the size and location of the thrombus.[48]University of Washington School of Medicine. Recommendations for management of superficial vein thrombosis. April 2015. https://depts.washington.edu/ (last accessed 4 November 2016).https://depts.washington.edu/anticoag/home/sites/default/files/Management%20of%20Superficial%20Vein%20Thrombosis.pdf

多普勒超声已被证明在诊断有症状和无症状的静脉近端深静脉血栓形成时具有高度敏感性 (>95%) 和特异性 (>95%)。[49]Wells PS, Owen C, Doucette S, et al. Does this patient have deep vein thrombosis? JAMA. 2006;295:199-207.http://www.ncbi.nlm.nih.gov/pubmed/16403932?tool=bestpractice.com[50]Pulliam CW, Barr SL, Ewing AB. Venous duplex scanning in the diagnosis and treatment of progressive superficial thrombophlebitis. Ann Vasc Surg. 1991;5:190-195.http://www.ncbi.nlm.nih.gov/pubmed/2015192?tool=bestpractice.com 尚不明确 SVT 的敏感性和特异性。

Ultrasonography may also be used for follow-up to confirm absence of thrombus propagation, especially in patients with a poor response to therapy.

浅表静脉缺乏可压缩的或管腔内的血栓

浅表真皮的小血管不受累是典型表现。[47]Rodriguez-Peralto JL, Carrillo R, Rosales B, et al. Superficial thrombophlebitis. Semin Cutan Med Surg. 2007;26:71-76.

早期病变中，有大量炎性细胞，主要为中性粒细胞浸润血管壁。静脉壁出现明显增厚，由炎性细胞渗出和水肿导致。内皮细胞肿胀。有血栓阻塞影响血管管腔，最终要进行血管再通。

A biopsy should be ordered in SVT cases that are recurrent and/or migratory, and when inflammatory diseases such as polyarteritis nodosa are being considered. This is best accomplished by an elliptical incision transverse to the long axis of the vessel rather than a punch biopsy.

静脉血栓累及皮下组织和更低的真皮的大型和中型静脉。

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 done.

exclude pulmonary embolism (PE)

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 done.

排除肺动脉栓塞

Indicated if pulmonary CT angiography or a VQ scan is non-conclusive and PE is still suspected.

排除肺动脉栓塞

以下情况需进行：在短静脉段的SVT患者伴随静脉曲张时；多普勒超声探查有广泛隐静脉血栓性静脉炎，有或没有伴随的深静脉血栓形成或肺动脉栓塞；或复发性或特发性SVT。

恶性肿瘤

筛查血栓形成倾向对于有短静脉SVT而没有静脉曲张患者而言是有用的；广泛的隐静脉血栓性静脉炎患者不论伴随或不伴随深静脉血栓或肺动脉栓塞，多普勒超声检查都是有必要的；包括复发性SVT和特发性SVT。然而，对于患有SVT的患者筛查血栓形成倾向的实用性和成本效益分析尚未得到充分研究。

存在凝血因子V Leiden突变和凝血酶原 G202010A 遗传变异；缺乏蛋白质S、C和抗凝血酶III；狼疮抗凝剂和抗心磷脂抗体阳性；高同型半胱氨酸血症