Post-thrombotic syndrome
Post-thrombotic syndrome (PTS), also called postphlebitic syndrome and venous stress disorder is a medical condition that may occur as a long-term complication of deep vein thrombosis (DVT).
Post-thrombotic syndrome
postphlebitic syndrome, venous stress disorder
Hematology
Signs and symptoms of PTS in the leg may include:[1]
These signs and symptoms may vary among patients and over time. With PTS, these symptoms typically are worse after walking or standing for long periods of time and improve with resting or elevating the leg.[1]
PTS lowers a person's quality of life after DVT, specifically with regards to physical and psychological symptoms and limitations in daily activities.[2][3][4]
Cause[edit]
Despite outgoing research, the cause of PTS is not entirely clear. Inflammation is thought to play a role[5][6] as well as damage to the venous valves from the thrombus itself. This valvular incompetence combined with persistent venous obstruction from thrombus increases the pressure in veins and capillaries. Venous hypertension induces a rupture of small superficial veins, subcutaneous hemorrhage[7] and an increase of tissue permeability. That is manifested by pain, swelling, discoloration, and even ulceration.[8]
Diagnosis[edit]
When physicians find a DVT in the clinical history of their patients, a postthrombotic syndrome is possible if the patients have suggestive symptoms. Ultrasonography for deep venous thrombosis must be performed to evaluate the situation: the degree of obstruction by clots, the location of these clots, and the detection of deep and/or superficial venous insufficiency.[16][17] Since signs and symptoms of DVT and PTS may be quite similar, a diagnosis of PTS should be delayed for 3–6 months after DVT diagnosis so an appropriate diagnosis can be made.[1]
Prevention[edit]
Prevention of PTS begins with prevention of initial and recurrent DVT. For people hospitalized at high-risk of DVT, prevention methods may include early ambulation, use of compression stockings or electrostimulation devices, and/or anticoagulant medications.[18] Elastic compression stockings may reduce the occurrence of PTS after clinically confirmed DVT.[19]
Increasingly, catheter-directed thrombolysis has been employed. This is a procedure in which a vascular interventionist will break up a clot using a variety of methods.
For people who have already had a single DVT event, the best way to prevent a second DVT is appropriate anticoagulation therapy.[20]
A second prevention approach may be weight loss for those who are overweight or obese. Increased weight can put more stress and pressure on leg veins, and can predispose patients to developing PTS.[13]
Society and culture[edit]
Treatment of PTS adds significantly to the cost of treating DVT. The annual health care cost of PTS in the United States has been estimated at $200 million, with costs over $3800 per patient in the first year alone, and increasing with disease severity.[24][25] PTS also causes lost work productivity: people with severe PTS and venous ulcers lose up to 2 work days per year.[26]
The field of PTS still holds many unanswered questions that are important targets for more research. Those include: