postthrombotic

Postthrombotic refers to the long-term sequelae that can follow a deep vein thrombosis (DVT). The most commonly described condition is postthrombotic syndrome (PTS), a chronic venous insufficiency syndrome caused by damage to venous valves and residual thrombus after a DVT, leading to venous hypertension in the affected limb.

Pathophysiology involves valvular damage that causes reflux and obstruction in the deep and superficial venous systems. Inflammation and venous remodeling contribute to edema, skin changes, and, in some cases, ulcers. The risk of developing PTS is greatest in the years after a DVT, with estimates suggesting that a substantial minority of patients may experience symptoms over time.

Clinical features include leg swelling and a feeling of heaviness or fullness, aches or cramps, fatigue, and itching. Chronic changes can include skin discoloration, dermatitis, venous eczema, and, in advanced cases, venous ulcers. Symptoms can vary from mild to debilitating and may worsen with prolonged standing or heat.

Diagnosis is primarily clinical, supported by scales such as the Villalta score to assess symptom severity and impact. Duplex ultrasonography can be used to evaluate residual venous reflux or obstruction, particularly when considering targeted interventions or evaluating alternative causes of leg symptoms.

Management focuses on symptom relief and prevention of complications. Core measures include graduated compression therapy, leg elevation, physical activity, and weight management. Wound care for ulcers and leg-directed care are important for advanced disease. Interventional options (for selected patients) include endovenous ablation, sclerotherapy for refluxing superficial veins, or venous stenting for proximal obstructions. Anticoagulation is indicated for acute DVT but is not a treatment for established PTS. Prevention emphasizes effective acute DVT treatment and, where appropriate, compression after DVT.