Posttrombotic

Posttrombotic syndrome (PTS) is a chronic venous insufficiency that can develop after a deep vein thrombosis (DVT). It arises from damage to venous valves and residual venous obstruction, which promote long-term venous hypertension in the affected leg. The condition may appear months to years after the initial DVT and tends to affect the leg where the clot occurred.

Clinical features of PTS include leg pain or aching, a feeling of heaviness, swelling that worsens with standing or during the day, cramps, and itching. Skin changes such as brown discoloration, lipodermatosclerosis, eczema, and, in more advanced cases, venous ulcers can occur. Risk factors for developing PTS include proximal DVT (iliac or femoropopliteal), recurrent DVT, obesity, older age, and inadequate compression therapy after DVT.

Diagnosis is primarily clinical, based on symptoms and examination. Duplex ultrasonography is used to exclude recurrent acute DVT and to assess venous reflux or obstruction. The CEAP classification (Clinical, Etiology, Anatomy, Pathophysiology) is commonly employed to stage disease and guide management.

Management focuses on reducing venous hypertension and edema and improving quality of life. Core therapies include graduated compression stockings (typically class II–III), leg elevation, and regular physical activity. Wound care and skin protection are important for ulcers or skin changes. Pharmacologic options such as venoactive drugs have variable evidence. In selected cases with persistent venous obstruction or reflux, endovascular procedures or surgical interventions may be considered, though these are not routinely required. Anticoagulation is not indicated for PTS unless there is an active thrombosis.

Prevention emphasizes prompt treatment of DVT, long-term compression after DVT when appropriate, and lifestyle measures to reduce obesity and prolonged venous stasis. PTS is generally a lifelong condition that can be managed but is not curable in most cases.