What are Treatment Options for Post-Thrombotic Syndrome?

Post-thrombotic syndrome (PTS) is a common complication that strikes patients who have had a deep vein thrombosis (DVT). PTS affects as many as 20-50 percent of DVT patients, and symptoms may not appear until years after a DVT. It causes leg pain, swelling, heaviness, itching or tingling, and discoloration, which may also lead to diminished quality of life1, 2. If untreated, the blood clot present with DVT can cause inflammation and damage to the valves which allow the blood to return to the heart. The obstruction and/or damaged valves ultimately diminish circulation and if left untreated, can eventually lead to more severe complications, such as venous ulcers. A venous ulcer is an open, shallow wound that appears on the lower leg, just above the ankle and below the calf.

It is these ulcers that make treatment of PTS so vital. Venous ulcers are time-consuming and costly to treat, consuming approximately 2% of healthcare spending in the United States. Because a large percentage of PTS patients develop complications, early diagnosis and treatment is imperative.

Traditional Treatments

a woman measures the fit of a compression stockingTypically, compression stockings are the first step in the care pathway3. They offer varying levels of support and should be fitted by a healthcare professional3. They are worn during the day and may be removed at night. Patients are generally placed on anticoagulation therapy (blood thinners) to prevent the recurrence of clots.

Endovascular Therapy

Angioplasty - ballon with stent

Angioplasty procedure – ballon with stent

Unfortunately, PTS patients may have an obstruction of one or more of the major veins returning blood to the heart. If this is the case, balloon angioplasty and venous stents are required to open the veins and allow adequate flow of the blood. Venous stenting is minimally invasive and safe, providing significant relief from symptoms4. This procedure has provided physicians with an alternative to bypass surgery, which is open surgery and produced results no better than angioplasty and stenting.

For patients whose disease has progressed to the stage of venous ulcers, venous stenting provided better resolution of the ulcers than compressive therapy and wound care alone. This treatment improves the quality of life of patients who are often uncomfortable5.

If you believe you may be suffering from post-thrombotic syndrome, please consult your physician

 

 

References:

1 – Prandoni P, Lensing A, CogoA, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med.1996;125(1):1-7.

2- Kahn SR, Shrier I, Julian JA, et al. Determinants and time course of the post-thrombotic syndrome after acute deep venous thrombosis. Ann Intern Med. 2008;149:698-707.

3 -Dr Susan R Kahn, MDcorrespondenceemail, Stan Shapiro, PhD, Philip S Wells, Compression stockings to prevent post-thrombotic syndrome: a randomised placebo-controlled trial Volume 383, No. 9920, p880–888, 8 March 2014

4 – Sarici IS1, Yanar F2, Agcaoglu O2, Ucar A3, Poyanli A3, Cakir S3, Aksoy SM2, Kurtoglu M2. Our early experience with iliofemoral vein stenting in patients with post-thrombotic syndrome. Pubmed 2013 May 3;29(5):298-303

5 – Konstantinos T. Delis, MD, PhD, FRCSI,* Haraldur Bjarnason, MD,† Paul W. Wennberg, MD,‡ Thom W. Rooke, MD,‡and Peter Gloviczki, M Successful Iliac Vein and Inferior Vena Cava Stenting Ameliorates Venous Claudication and Improves Venous Outflow, Calf Muscle Pump Function, and Clinical Status in Post-Thrombotic Syndrome Ann Surg. 2007 Jan; 245(1): 130–139.

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