Post-thrombotic syndrome is a fairly common he alth problem that is a chronic complication of deep vein thrombosis (DVT). It is estimated that as many as 23-60% of patients after an episode of thrombosis develop symptoms resulting from venous insufficiency within 2 years. The post-thrombotic syndrome, like the thrombosis itself, mainly affects the lower limbs.

Postthrombotic syndrome (PTS) can be a complication of various circulation problems in the lower extremities, but is most often diagnosed as a complication of deep vein thrombosis (DVT) . Importantly, the symptoms of thrombotic syndrome may appear months or even years later.

Post-thrombotic syndrome: causes

The exact cause of the post-thrombotic syndrome is unclear. Undoubtedly, however, it can be seen in the damage and inefficiency of the deep vein system - the vessels responsible for draining blood from the lower limbs towards the heart.

It is postulated that the primary causative factor is the incomplete dissolution of the clot, which, by organizing and becoming fibrotic, may permanently restrict the patency of the venous vessel.

One hypothesis is thrombosis-secondary damage to the venous valve system, the primary task of which is to prevent blood reflux.

The etiology of this disorder is complex, but the symptoms of the syndrome are caused by impaired blood outflow from the lower limbs.

The result is increased pressure in the venous circulation, which damages small vessels and surrounding tissues.

Post-thrombotic syndrome: symptoms

The symptoms of post-thrombotic syndrome can vary widely. They cover the range of symptoms characteristic of chronic venous insufficiency. The main symptoms (experienced by the patient) include:

  • feeling of heavy legs
  • pain in a limb - permanent or periodic, it may be like cramps
  • tingling, itching

It is typical for discomforts to worsen when walking or standing for long periods, and to ease when resting in a supine position, especially with raised legs.

The extremities affected by the post-thrombotic syndrome also undergo a number of changes, such as:

  • swelling of the limb - usually the earliest symptom
  • occurrence of varicose veins - usually preceded by telangiectasias (widened with tiny vessels, so-called "spiders")
  • brown or reddish skin discoloration
  • hardening of the subcutaneous tissue of the lower leg

In the most severe, advanced cases, venous ulcers are difficult to heal. Their typical location is the area of ​​the medial ankle, i.e. on the inside of the shin.

Post-thrombotic syndrome: diagnosis

The recognized and most likely significant risk factors for the development of post-thrombotic syndrome include:

  • older age (>65 years old)
  • obesity (BMI>=30kg / m2)
  • occurrence of varicose veins before an episode of thrombosis
  • recurrence of thrombosis on the same side
  • thrombosis in the proximal veins (e.g. in the femoral and iliac veins)
  • DVT without any symptoms
  • DVT symptoms persist one month after diagnosis
  • treatment of DVT with too low doses of anticoagulants or non-compliance with medical recommendations

Post-thrombotic syndrome: diagnosis

The diagnosis of post-thrombotic syndrome is usually based on a medical history of the symptoms and a history of thrombosis, as well as clinical examination of changes in the limbs.

The timing criterion is essential for the diagnosis of post-thrombotic syndrome. It can be diagnosed 3 months after the onset of DVT.

The Doppler ultrasound examination is helpful in the accurate assessment of flow disturbances in the venous system, especially when deciding on surgical treatment.

Post-thrombotic syndrome: treatment

Treatment of chronic venous insufficiency, especially that caused by post-thrombotic syndrome - is a difficult and backbreaking task.

In addition to administering appropriate treatment, the patient's patience and self-discipline are very important. Therefore, prevention has an important task.

It is very important to treat the thrombosis itself. Adequately long, regular use of anticoagulants in appropriate doses significantly reduces the risk of post-thrombotic syndrome.

One of the key methods is compression treatment, the assumption of which is to improve the outflow of venous blood from the lower extremities, and consequently to improve clinical symptoms and slow down the development of the disease. The methods of compression therapy include the use of:

  • gradual compression stockings (the highest pressure is at the ankles, decreasing with height),
  • bandages and bandscompression (used in co-occurrence of ulcerations)
  • intermittent pneumatic compression (PUP)

The compression method and the pressure exerted (expressed in mmHg) are selected mainly based on the severity of the disease. Compression therapy is used at every stage of treatment - both in the prevention of post-thrombotic syndrome and the treatment of severe venous ulcers.

In the prevention and initial stage of the treatment of the syndrome, stockings, the so-called Class II (out of a total of four compression classes) that exert a pressure of 30-40mmHg at the ankle.

It is not uncommon for compression treatment to last for many years and may be constantly necessary.

Alternatively, pharmacological treatment is also used, which is less effective. These are mainly preparations containing pentoxifylline, diosmin, escin or calcium dobesylate.

Activities aimed at treating advanced trophic changes - removing necrotic tissues, applying dressings for ulcers, performing skin transplants and combating pain and co-occurring infections are also an important element.

High hopes are placed on the development of surgical methods of treating the anticoagulant syndrome.

These include, among others more and more often used methods of angioplasty consisting in percutaneous restoration of venous vessels with the use of stents and open operations based on the creation of vascular "bypass".

The treatment methods still require research to document their effectiveness more clearly. Sources:

  1. Ashrani AA, Heit JA (2009). "Incidence and cost burden of post-thrombotic syndrome"
  2. "Risk factors for post-thrombotic syndrome in patients with a first deep venous thrombosis" Authors: L. W. TICK, M. H. H. KRAMER, F. R. ROSENDAAL, W. R. FABER, C. J. M. DOGGEN
  3. "Postthrombotic Syndrome" Sara R. Vazquez, PharmD, BCPS, CACP; Susan R. Kahn, MD, MSc, FRCPC
  4. Interna Szczeklika 2022/18; Practical Medicine

Category:

Cardiology