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Post-thrombotic syndrome

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of post-thrombotic syndrome are prepared by our editorial team based on guidelines from the European Society for Vascular Surgery (ESVS 2022,2021), the American College of Chest Physicians (ACCP 2021), the Interdisciplinary Expert Panel on Iliofemoral Deep Vein Thrombosis (InterEPID 2015), the American Heart Association (AHA 2014), the Society for Vascular Surgery ...
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Classification and risk stratification

Severity assessment: as per ESVS 2022 guidelines, consider using the r-VCSS and the Villalta scale for PTS for the assessment of clinical severity and treatment success in patients with chronic venous disease.
B
Villalta score for post-thrombotic syndrome
Pain
Absent
Mild
Moderate
Severe
Cramps
Absent
Mild
Moderate
Severe
Heaviness
Absent
Mild
Moderate
Severe
Paresthesia
Absent
Mild
Moderate
Severe
Pruritus
Absent
Mild
Moderate
Severe
Pretibial edema
Absent
Mild
Moderate
Severe
Skin induration
Absent
Mild
Moderate
Severe
Hyperpigmentation
Absent
Mild
Moderate
Severe
Redness
Absent
Mild
Moderate
Severe
Venous ectasia
Absent
Mild
Moderate
Severe
Pain on calf compression
Absent
Mild
Moderate
Severe
Venous ulcer
Absent
Present
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Medical management

Vasoactive agents: as per AHA 2014 guidelines, insufficient evidence to support the use of rutosides, hidrosmin, or defibrotide for the treatment of patients with PTS.
I

Nonpharmacologic interventions

Compression stockings: as per ESVS 2022 guidelines, consider offering below knee elastic compression stockings exerting a pressure of 20-40 mmHg at the ankle to reduce the severity of symptoms in patients with PTS.
C

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  • Physical therapy

Therapeutic procedures

Intermittent pneumatic compression: as per ESVS 2022 guidelines, consider offering adjuvant intermittent pneumatic compression to reduce the severity of symptoms in patients with PTS.
C

Surgical interventions

Indications for surgery: as per ESVS 2022 guidelines, consider performing surgical or hybrid deep venous reconstruction in patients with iliac vein outflow obstruction and severe PTS, if endovascular options alone are not appropriate.
C

Specific circumstances

Patients with venous leg ulcers: as per AHA 2014 guidelines, offer compression therapy in preference to primary dressing alone or non-compression bandage for the treatment of venous ulcers in patients with PTS.
A
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  • Patients with iliofemoral DVT

Preventative measures

Primary prevention, compression stockings: as per ACCP 2021 guidelines, avoid using compression stockings routinely to prevent PTS in patients with acute DVT of the leg.
D

More topics in this section

  • Primary prevention (thromboprophylaxis)

  • Primary prevention (catheter-directed thrombolysis)

  • Primary prevention (systemic thrombolysis)

  • Primary prevention (surgical thrombectomy)