Abstract
Venous insufficiency following deep venous thrombosis is known as the post thrombotic syndrome. Whilst its presentation and symptoms can vary slightly between individuals, it can have a profound effect on quality of life. Symptoms range from mild limb swelling to severe intractable ulceration. A number of scoring systems have been developed to help monitor the disease progression, response to treatment as well as to classify patients for research purposes.
Treatment involves a combination of therapies, including compression stockings, venous stenting for out flow obstruction and in some instances deep venous bypass. A considerable effort is made in preventing post thrombotic syndrome with a number of trials looking into the effect of prompt and stable anticoagulation, the effect of compression stockings, the effect of exercise and the outcomes following early thrombus removal strategies such as catheter directed and pharmacomechanical thrombolysis.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- PTS:
-
post thrombotic syndrome
- DVT:
-
deep vein thrombosis
- CDT:
-
catheter directed thrombolysis
- LMWH:
-
Low molecular weight heparin
- VKA:
-
Vitamin K Antagonists
- PMT:
-
Pharmaco-mechanical thrombolysis
References
Galanaud JP, Laroche JP, Righini M (2013) The history and historical treatments of deep vein thrombosis. J Thromb Haemost 11(3):402–411
Kahn SR (2009) How I treat postthrombotic syndrome. Blood 114(21):4624–4631
Stranden E (2011) Edema in venous insufficiency. Phlebolymphology 18(1):3
Baldwin MJ, Moore HM, Rudarakanchana N, Gohel M, Davies AH (2013) Post-thrombotic syndrome: a clinical review. J Thromb Haemost 11(5):795–805
Kahn SR, Desmarais S, Ducruet T, Arsenault L, Ginsberg JS (2006) Comparison of the Villalta and Ginsberg clinical scales to diagnose the post-thrombotic syndrome: correlation with patient-reported disease burden and venous valvular reflux. J Thromb Haemost 4(4):907–908
Kahn SR (2009) Post-thrombotic syndrome after deep venous thrombosis: risk factors, prevention, and therapeutic options. Clin Adv Hematol Oncol 7(7):433–435
Villalta S, Bagatella P, Piccioli A, Lensing AW, Prins MH, Prandoni P (1994) Assessment of validity and reproducibility of a clinical scale for the postthrombotic syndrome. Haemostasis 24:158A
Soosainathan A, Moore HM, Gohel MS, Davies AH (2013) Scoring systems for the post-thrombotic syndrome. J Vasc Surg 57(1):254–261
Kahn SR, Partsch H, Vedantham S, Prandoni P, Kearon C, on behalf of the Subcommittee on Control of Anticoagulation of the S et al (2009) Definition of post-thrombotic syndrome of the leg for use in clinical investigations: a recommendation for standardization. J Thromb Haemost 7(5):879–883
Eklof B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL et al (2004) Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg 40(6):1248–1252
Passman MA, McLafferty RB, Lentz MF, Nagre SB, Iafrati MD, Bohannon WT et al (2011) Validation of Venous Clinical Severity Score (VCSS) with other venous severity assessment tools from the American Venous Forum, National Venous Screening Program. J Vasc Surg 54(6, Supplement):2S–9S
Vasquez MA, Rabe E, McLafferty RB, Shortell CK, Marston WA, Gillespie D et al (2010) Revision of the venous clinical severity score: venous outcomes consensus statement: Special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg 52(5):1387–1396
Kahn SR, Ducruet T, Lamping DL, Arsenault L, Miron MJ, Roussin A et al (2005) Prospective evaluation of health-related quality of life in patients with deep venous thrombosis. Arch Intern Med 165(10):1173–1178
Kahn SR, Shbaklo H, Lamping DL, Holcroft CA, Shrier I, Miron MJ et al (2008) Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J Thromb Haemost 6(7):1105–1112
Van den Oever R, Hepp B, Debbaut B, Simon I (1998) Socio-economic impact of chronic venous insufficiency. An underestimated public health problem. Int Angiol J Int Union Angiol 17(3):161–167
MacDougall DA, Feliu AL, Boccuzzi SJ, Lin J (2006) Economic burden of deep-vein thrombosis, pulmonary embolism, and post-thrombotic syndrome. Am J Health Syst Pharm AJHP Off J Am Soc Health Syst Pharm 63(20 Suppl 6):S5–S15
Kahn S, Shrier I, Shapiro S, Houweling AH, Hirsch A, Reid R et al (2009) A randomized, controlled two-center pilot trial of a 6-month exercise training program to treat the post-thrombotic syndrome: the expo pilot trial. Blood 114(22):37–44
Agu O, Baker D, Seifalian AM (2004) Effect of graduated compression stockings on limb oxygenation and venous function during exercise in patients with venous insufficiency. Vascular 12(1):69–76
Kahn SR, Azoulay L, Hirsch A, Haber M, Strulovitch C, Shrier I (2003) Effect of graduated elastic compression stockings on leg symptoms and signs during exercise in patients with deep venous thrombosis: a randomized cross-over trial. J Thromb Haemost 1(3):494–499
Ginsberg JS, Magier D, Mackinnon B, Gent M, Hirsh J (1999) Intermittent compression units for severe post-phlebitic syndrome: a randomized crossover study. CMAJ 160(9):1303–1306
O’Donnell MJ, McRae S, Kahn SR, Julian JA, Kearon C, Mackinnon B et al (2008) Evaluation of a venous-return assist device to treat severe post-thrombotic syndrome (VENOPTS). A randomized controlled trial. Thromb Haemost 99(3):623–629
Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, et al. (2012) Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th edn. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl): e419S–e494S
Kahn SR, Comerota AJ, Cushman M, Evans NS, Ginsberg JS, Goldenberg NA et al (2014) The postthrombotic syndrome: evidence-based prevention, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation 130(18):1636–1661
Smith PC (2005) Daflon 500 mg and venous leg ulcer: new results from a meta-analysis. Angiology 56(Suppl 1):S33–S39
Gohel MS, Davies AH (2010) Pharmacological treatment in patients with C4, C5 and C6 venous disease. Phlebology 25(Suppl 1):35–41
Jull A, Waters J, Arroll B (2002) Pentoxifylline for treatment of venous leg ulcers: a systematic review. Lancet 359(9317):1550–1554
Jantet G (2002) Chronic venous insufficiency: worldwide results of the RELIEF study. Reflux assEssment and quaLity of lIfe improvEment with micronized Flavonoids. Angiology 53(3):245–256
Neglen P, Hollis KC, Olivier J, Raju S (2007) Stenting of the venous outflow in chronic venous disease: long-term stent-related outcome, clinical, and hemodynamic result. J Vasc Surg 46(5):979–990
Raju S, Ward M Jr, Kirk O (2014) A modification of iliac vein stent technique. Ann Vasc Surg 28(6):1485–1492
Pavcnik D, Kaufman J, Machan L, Uchida B, Keller FS, Rosch J (2005) Percutaneous therapy for deep vein reflux. Semin Interv Radiol 22(3):225–232
Kahn SR (2010) The post-thrombotic syndrome. Hematol Educ Program Am Soc Hematol 2010:216–220
van Dongen CJ, Prandoni P, Frulla M, Marchiori A, Prins MH, Hutten BA (2005) Relation between quality of anticoagulant treatment and the development of the postthrombotic syndrome. J Thromb Haemost 3(5):939–942
Galanaud J-P, Righini M, Quéré I et al (2014) Compression stockings to prevent post-thrombotic syndrome. Lancet 384(9938):129
Hull RD, Pineo GF, Brant R, Liang J, Cook R, Solymoss S et al (2009) Home therapy of venous thrombosis with long-term LMWH versus usual care: patient satisfaction and post-thrombotic syndrome. Am J Med 122(8):762.e3–769.e3
Enden T, Haig Y, Klow NE, Slagsvold CE, Sandvik L, Ghanima W et al (2012) Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet 379(9810):31–38
Kahn SR, Shapiro S, Wells PS, Rodger MA, Kovacs MJ, Anderson DR et al (2013) Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial. Lancet 383:880–888
Chong L-Y, Fenu E, Stansby G, Hodgkinson S (2012) Management of venous thromboembolic diseases and the role of thrombophilia testing: summary of NICE guidance. BMJ 344:e3979
Musani MH, Matta F, Yaekoub AY, Liang J, Hull RD, Stein PD (2010) Venous compression for prevention of postthrombotic syndrome: a meta-analysis. Am J Med 123(8):735–740
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Busuttil, A., Lim, C.S., Davies, A.H. (2016). Post Thrombotic Syndrome. In: Islam, M. (eds) Thrombosis and Embolism: from Research to Clinical Practice. Advances in Experimental Medicine and Biology(), vol 906. Springer, Cham. https://doi.org/10.1007/5584_2016_126
Download citation
DOI: https://doi.org/10.1007/5584_2016_126
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-22107-6
Online ISBN: 978-3-319-22108-3
eBook Packages: MedicineMedicine (R0)