Posttrombotisen

Posttrombotisen, also known as postthrombotic syndrome (PTS), is a chronic complication that can follow a venous thromboembolism, most often a proximal deep vein thrombosis (DVT). It occurs when damage to the venous valves and persistent venous hypertension in the leg lead to long-term venous insufficiency. The condition is a major cause of leg symptoms after DVT.

Symptoms include leg heaviness, aching or burning pain, swelling, fatigue, cramps, and itching. Skin changes such as darkened skin, leathery texture, and, in advanced cases, venous ulcers may develop, especially around the ankles.

Pathophysiology involves valvular reflux, valvular obstruction, inflammation, and chronic venous hypertension that damages tissues and impairs microcirculation. Risk factors for developing PTS after DVT include proximal (iliac or femoral) DVT, extensive thrombus, recurrent DVT, older age, obesity, immobility, and inadequate or incomplete initial anticoagulation.

Diagnosis is clinical, often supported by scoring systems such as the Villalta scale, and by duplex ultrasound to assess venous reflux or obstruction. It is distinguished from acute DVT by its chronic, ongoing symptoms.

Management focuses on symptom relief and prevention of ulcers. Core measures include graduated compression stockings, leg elevation, and regular exercise. Skin care and wound management are essential for ulcers. In selected cases, endovenous procedures or surgery may be considered for severe venous reflux or outflow obstruction; smoking cessation and weight management help overall outcomes.

Prevention after DVT emphasizes effective anticoagulation to reduce recurrence and use of compression therapy to minimize venous hypertension. Many patients experience stabilization over time, but PTS can be a long-term problem for some.