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Post-Thrombotic Syndrome (PTS)


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An estimated 330,000 people in the United States have post-thrombotic syndrome (PTS). Typically, the more extensive the DVT, the more severe the symptoms of PTS will be. However, this is not always so: even people who have had very extensive acute DVTs with severe symptoms may recover completely and may not be left with any long-term symptoms. Approximately 60% of patients will recover from a leg DVT without any residual symptoms, 40% will have some degree of PTS, and 4% will have severe symptoms. The symptoms of PTS usually occur within the first 6 months, but can occur up to 2 years after the clot. If a patient has done well for 1⁄2 – 2 years after the clotting event it is highly unlikely that he/she will develop PTS.

Little is known as to who will develop chronic symptoms and who will not. However, it is known that people with DVT who wear daily compression stockings for several months after the acute DVT will develop significantly less PTS symptoms. The stocking should be custom fitted, i.e. a person’s leg should be measured to find a stocking that fits well. It needs to have a certain compression pressure; 35mmHg (mercury) at the ankle, 25mmHg at the mid-calf, and 18mmHg just below the knee. If the leg swelling is below the knee, then a below-knee stocking is appropriate, but if swelling also involves the thigh, then an above-knee stocking should probably be worn.

Symptoms and signs of PTS include chronic extremity swelling, chronic (or waxing and waning) pain, unspecific discomfort of the extremity, diffuse aching, heaviness, tiredness and cramping of extremity, dark skin pigmentation (Hemosiderosis), bluish discoloration of toes/fingers, foot/hand or diffusely of leg/arm, skin dryness, eczema, hardening of the skin (Lipodermatosclerosis), formation of varicose veins, skin ulcer (stasis ulcer), and “atrophie blanche”.

Treatment options include high grade compression stockings, periodic leg elevation, weight loss, increased exercise with strengthening of extremity muscles, pain management and sometimes the use of a compression pump may be helpful.
In patients with scarring of the vein wall, angioplasty and stenting may offer significant relief of symptoms.

Venous stasis ulcers resulting from dilation and reflux of perforator branches or superficial veins may be treated with a variety of endovenous procedures. Often leg swelling will improve with the treatment of superficial vein reflux, however, chronic compression therapy is still needed regardless of the outcome.