postthrombotisches

Postthrombotic syndrome (PTS) is a chronic complication that can follow an episode of deep vein thrombosis (DVT). It arises from lasting damage to venous valves and/or residual venous obstruction, which promotes venous hypertension in the affected limb and leads to ongoing symptoms and functional impairment.

Epidemiology and risk factors vary with definitions and follow-up, but PTS is considered a relatively common sequela of DVT. Risk factors for developing PTS include extensive or proximal DVT, recurrent thrombotic events, obesity, advanced age, and inadequate compression therapy or rehabilitation after the initial DVT.

Pathophysiology is driven by two main processes: valvular reflux, where damaged venous valves fail to prevent backflow, and chronic venous obstruction from organized thrombus. Together, these factors raise venous pressure, causing edema, skin changes, and, in severe cases, venous ulcers.

Clinical presentation ranges from mild leg discomfort, heaviness, and swelling to significant pain, itching, dermatitis, and venous ulcers. Symptoms often worsen with standing and improve with leg elevation. Diagnosis is primarily clinical, using tools such as the Villalta score to quantify symptoms and signs. Duplex ultrasonography assesses residual reflux and obstruction and helps exclude other causes of leg swelling.

Prevention focuses on optimal initial DVT treatment and ongoing compression therapy. Management emphasizes compression stockings, leg elevation, and regular exercise; wound care for ulcers; and symptom control. In selected cases, referral to vascular specialists for advanced interventions (such as treatment of venous reflux or iliac vein obstruction) may be appropriate.

Prognosis is variable; PTS tends to be a chronic, fluctuating condition that can improve with conservative therapy but may persist for years in some patients.