Post-thrombotic syndrome
Post-thrombotic syndrome is chronic venous insufficiency developing after deep vein thrombosis, from valvular damage and residual obstruction. It causes chronic limb pain, swelling, skin changes, and sometimes ulcers, is graded by the Villalta score, and is managed with compression, exercise, and, for severe iliofemoral disease, venous stenting.
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What this article covers
- Overview
Definition: post-thrombotic syndrome is chronic venous insufficiency that develops in a limb after deep vein thrombosis, from persistent venous obstruction and valvular reflux.
- Epidemiology
A common sequela of deep vein thrombosis, developing in a substantial minority.
- Risk factors
Proximal (iliofemoral) and extensive deep vein thrombosis.
- Pathophysiology
Residual obstruction and reflux: incomplete thrombus resolution leaves obstruction, and valve damage causes reflux.
- Clinical features
Chronic limb pain, heaviness, and aching worse with standing.
- Differential diagnosis
Recurrent deep vein thrombosis: acute limb worsening that must be excluded, distinguished from post-thrombotic syndrome by a new non-compressible intraluminal thrombus on duplex ultrasound.
- Diagnosis
Establish clinically by chronic venous symptoms and signs after deep vein thrombosis, graded by the Villalta score, after excluding recurrent thrombosis: the diagnostic basis is characteristic…
- Management
First-line, compression therapy and exercise: graduated compression stockings and a structured exercise (calf muscle pump) program, with leg elevation and weight management, after confirming adequate arterial supply.
- Complications
Chronic venous ulceration. Recurrent cellulitis and venous eczema.
- Prognosis
Often chronic, but symptoms improve with compression and exercise.
- Prevention
Adequate anticoagulation of the index deep vein thrombosis for at least 3 months.
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