Treatment of superficial thrombophlebitis.

Abstract

To The Editor: Superficial thrombophlebitis occurring in the legs associated with varicose veins is a chronic condition which does not readily respond to treatment. It often necessitates frequent office visits and sometimes complete bedrest or hospitalization. Many forms of therapy have been advocated, especially the daily intramuscular injections of trypsin in oil, which is the treatment presently in vogue. Patients have worn supporting bandages for months, have had anticoagulant therapy, superficial x-ray therapy to the areas of inflammation, rest in bed, elevation of the legs and applications of heat, and stripping operations on the veins The foregoing procedures have resulted in improvement or cure, but the treatment has been prolonged and the relief of discomfort has not been rapid. In my use of these forms of therapy I have not been impressed with the rapidity of improvement in symptoms such as pain, tenderness and local muscle spasm. Recently, in an attempt to limit the pain and muscle spasm which accompanied this condition, I injected small amounts of hydrocortisone acetate suspension (25 mg. per cc.) combined with tetracaine hydrochloride (Pontocaine, 0.15 per cent solution). Each injection contained 0.5 cc. of the hydrocortisone suspension and 1.0 cc. of the tetracaine solution, and was given directly into the painful indurated area of the thrombotic process with a fine needle. The results were very satisfactory. The pain and tenderness improved rapidly, and the next day every patient so treated announced that there had been great improvement. I originally started treatment on many of these patients with daily intramuscular injections of trypsin, rest, elevation and a support bandage; but after starting the use of hydrocortisone in tetracaine locally, the results were immediate and gratifying. I have used this treatment in over 20 cases without any ill effects, and there has been no sloughing of tissue or ulceration. Two injections at intervals of two to three days were sufficient in the great majority of cases; a few patients required three injections. Observations made three months after treatment revealed complete recovery and no relapse in any of the patients treated. Conclusions: Treatment of superficial thrombophlebitis by the local injection of hydrocortisone suspension combined with tetracaine solution has yielded good results. Pain, swelling, and disability have been greatly improved, and there have been no untoward effects. The response to treatment is rapid, compared to that following other methods, and I have adopted this procedure as the one of choice in the treatment of superficial thrombophlebitis of the legs.