Patients with phlebitis or thrombosis often experience pain in their limbs for several days before consulting a doctor. However, this blockage of a vein by a blood clot needs to be treated quickly. Dr. Ariel Toledano, vascular doctor and phlebologist in Paris, explains in "Without appointment" Wednesday everything you need to know about phlebitis. 

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Phlebitis manifests as sharp pain and swelling in the calf, thigh, or more rarely in the arm. Favored by immobilization, a phlebitis can lead to a pulmonary embolism. Guest of "Sans Rendez-Vous" on Wednesday, Dr. Ariel Toledano, vascular doctor and phlebologist in Paris, explains on Europe 1 how to recognize a phlebitis, its risk factors and its treatment. 

>> Find the whole of Sans rendez-vous in replay and podcast here

How is phlebitis manifested? 

Phlebitis or thrombosis is "a clot that appears in a vein and occludes it," says Dr. Ariel Toledano. This generates pain, which often becomes intense in patients, who are then forced to consult. It manifests itself by "the appearance of edema, swelling in the calf for example, which becomes a little red and painful", describes the vascular doctor. "When the pain appears unilaterally, it is synonymous with phlebitis," he summarizes. 

Should we always worry about the risk of pulmonary embolism?

"Any phlebitis will not give a pulmonary embolism," reassures the phlebologist. "Some, when they are not treated, will migrate, that is to say that the clot will go up to the level of the veins of the lower limbs to go even higher, until reaching the pulmonary arteries", details t -he. But "it is really necessary that the clot is located high enough" so that there is a risk of making a pulmonary embolism. 

The higher the clot, for example, at the thigh, the more likely it is to generate a pulmonary embolism. "If it is low, there is less risk because it must go up all the lower limb," he adds.

If "80% of thromboses mainly affect the lower limbs", it can also be done in the upper limbs, that is to say in the arm or forearm. "It often happens in a particular context when the vein has been particularly irritated after an infusion or a blood test for example", but it remains "much rarer", underlines Dr Ariel Toledano. 

Who are the populations most at risk? 

"Before the age of 40, there is almost one in 10,000 people who will develop phlebitis so it is still quite rare," said the vascular doctor. After 75 years, "it's one in a hundred people". In short, the older you get, the more likely you are to develop phlebitis. 

Pregnancy is also a risk factor. "When you're pregnant, you're five times more likely to get phlebitis," says the doctor. "Pregnant women must therefore be very vigilant, especially those who have a history, or who have had phlebitis," he warns.  

Certain inflammatory diseases such as ulcerative colitis can also promote phlebitis. Just like cancer, or stillness. For example, when you have to be hospitalized and you are not going to move from your bed or if you stay at home without moving, as during confinement. "When we do not move, we do not mobilize the calf muscles which help the blood to rise. If in addition, we do not hydrate enough, the blood becomes less fluid and a clot can form", explains Ariel Toledano .

Phlebitis can also be hereditary since in some people blood coagulates more easily and this is hereditary. This is why it is necessary, before starting a contraceptive, to do a blood test to check if there is a bleeding disorder. "Phlebitis appears in young women who start contraceptive treatment," he notes.

Is there a risk of phlebitis during a long trip by plane or car?

A person is more likely to develop phlebitis after a long trip by plane than by train or car. "In an airplane, pressurizing the cabin increases the risks," notes Dr. Ariel Toledano. But when a person who is at risk or who has already had phlebitis is preparing for a long trip by car, "you have to be vigilant and prepare the ground". So, one can choose to wear compression socks which can help or sometimes take treatment. 

What to do when you think you have a phlebitis?

It is best to talk to your GP, who will refer you to a vascular doctor who will immediately start treatment. When someone consults for phlebitis, "the urgency is obvious". It is therefore necessary to make the diagnosis. "We cannot limit ourselves to the clinic. We have to identify and locate the clot thanks to a Doppler ultrasound", specifies the doctor. And we must distinguish two types of phlebitis: superficial phlebitis which affects the superficial venous network and deep phlebitis which affects the deep venous network, which is much more serious and includes a higher risk of pulmonary embolism. 

But Dr. Ariel Toledano warns: "All this can be done very quickly, we do not wait three or four days" because very often patients wait several days after the onset of pain. "When you have phlebitis, it is important to look for the cause," he insists. "Once you have the cause and the cause is treated, you no longer need to treat phlebitis. But if the cause persists, you may need to take treatment for a longer time." 

How to treat a phlebitis? 

"90% of phlebitis is treated at home today," says the doctor. Except when the phlebitis are very high and there is a real risk of pulmonary embolism. "At that time, we prefer to hospitalize the patients so that they are close to an intensive care unit for the care in case of respiratory problems".

Regarding treatment, we are no longer forced to make injections as before, even if it still concerns cancer patients. "For ten years, we have had new treatments, direct oral anticoagulants which make it possible to treat phlebitis easily without doing regular blood tests", underlines Ariel Toledano. Each patient receives a treatment adapted to his case.

As for the duration of treatment, it varies depending on the location of the phlebitis and whether it is a recurrence or a first episode. When it is the first time this happens, "in general, the duration of treatment is between six weeks and three months", but when it is a recurrence, "the duration of treatment increases to six months".

Are compression stockings really useful?

"It is very important to keep the restraint for at least three to six months," says Dr Ariel Toledano. The sooner the compression stockings are put on, the less the risk of complications. "When a clot forms in the wall, it can degrade it permanently and cause deep reflux of the vein. So it is important to continue to wear compression stockings to help the weakened vein to be more functional", he explains.

Can a muscle tear turn into phlebitis?

"It's quite common," says the doctor. "On the return from the ski holidays, people often had muscle tears. And the immobility that the muscle tear caused could lead to thrombosis or it could have been associated with it," he explains. he. "When we give treatments for a muscle tear and we also have phlebitis, it is a little more complex because it will delay the healing of the muscle since we will give an anticoagulant treatment", adds the phlebologist.