Postthrombotic Syndrome

Postthrombotic syndrome (PTS) is the most frequent complication of deep vein thrombosis (DVT). After a proximal DVT, 20–50 % of patients will develop PTS and 5–10 % of patients will develop severe PTS, which reduces quality of life and has important socioeconomic consequences. PTS is diagnosed on clinical grounds, based on the presence of signs and symptoms of venous insufficiency in the leg ipsilateral to DVT. The Villalta scale, a clinical scale that incorporates venous symptoms and signs, is a recommended standard for the diagnosis of PTS. Clinical predictors of PTS have been progressively characterized, but the ability to predict which patient with DVT is likely to develop PTS remains limited. A number of risk factors for PTS have been identified; of these, proximal location of DVT and a previous ipsilateral DVT are the most important. Treatment options for PTS are limited, and strategies that prevent PTS occurrence are therefore of pivotal importance. These include prevention of DVT with the use of thromboprophylaxis in high-risk surgical and medical patients, prevention of recurrent ipsilateral DVT with the use of optimal and/or prolonged duration of anticoagulation, and possibly, compression therapy and endovascular catheter-directed thrombolytic procedures.