Post-thrombotic syndrome (PTS) is a syndrome of chronic venous insufficiency following deep vein thrombosis (DVT) due to valvular incompetence, which results in chronic reflux and chronic venous hypertension.
PTS is a common complication following extensive DVT of the limbs. Up to half of the patients with iliofemoral or iliocaval DVT develop PTS within two years.
Patients present with limb swelling, pain, discolouration and pigmentation, varicose veins, and in rare cases venous ulcers.
Thrombotic obstruction of the deep vein incites an inflammatory response by increasing level of cytokines or adhesion molecules in an attempt to recanalize the thrombose which can permanently damage venous valves. Damaged venous valves result in reflux and stasis, hence chronic venous hypertension.
Treatment and prognosis
For prevention, long-term anticoagulation, compression stockings, weight loss, and smoking cessation are recommended.
Pharmacologic therapies such as pentoxifylline and rutosides have been tried successfully for patients with venous ulcers. Intermittent pneumatic compression and trainer-supervised exercise therapy shown to be effective in improvement of symptoms.
In selected patients with severe disease and ulcers, endovascular stents may be considered. Endovenous thermal ablation (EVTA) - with radiofrequency or laser - of great saphenous or small saphenous veins shown to improve reflux to the deep venous system.
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