Phlebosclerosis, phlebothrombosis, and thrombophlebitis: A current perspective

Phlebosclerosis, phlebothrombosis, and thrombophlebitis are three fundamentally different structural changes affecting superficial, deep, visceral, and cerebral veins. Phlebosclerosis is a frequent, age-dependent fibrotic degeneration of one or all three wall layers. It does not represent a distinct disease entity but may impair the venous function and contribute to the development of thrombosis. Phlebothrombosis represents a serious circulatory disorder. It may be due to a variety of factors including phlebitis, i.e., a primary inflammatory disease of the venous wall. Thrombophlebitis may be a relatively harmless disorder, such as represented by idiopathic skipping phlebitis (phlebitis saltans), or it may be a symptom of an underlying systemic disease. Whereas phlebothrombosis in nonvaricose veins is suspicious of an underlying malignancy or a coagulation disorder, thrombophlebitis is not related to malignancies but may accompany Buergerʹs disease or other systemic vasculitides. The histopathological distinction of phlebothrombosis and thrombophlebitis is therefore of paramount importance and determines further clinical investigations. A proposal for classification of thrombophlebitides and some guidelines for clinicopathological differentiation of the various types of phlebitides are presented.