Narrative review on the management of post-thrombotic syndrome: approaching the emerging technologies

Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) and the most challenging form of chronic venous disease. Up to 50% of patients who suffer DVT will develop PTS. Clinical manifestations such as limb pain, edema, skin damage, and ulceration result from venous hypertension due to reflux, obstruction, or a combination of both. The current treatment option is conservative management with limited efficiency. PTS severely affects the quality of life, and definitive surgical treatment is urgently needed. This article aims to review the current management paradigm and introduce new in-development surgical alternatives. A narrative review of the literature published between 2010 and 2025 was conducted in PubMed, Embase and the Cochrane Library. Reviewed articles included management guidelines, trial reports, reviews, and cohort studies regarding the management of post-thrombotic syndrome and deep valvular insufficiency. The SANRA Guidelines for narrative reviews were followed. Sixty-seven articles addressing current and future treatment options for PTS were included. Over the last five decades, previous unsuccessful attempts to restore deep valvular function provided the knowledge ground for promising candidates. Technological improvements within the last decade have taken a novel implantable bioprosthetic valve, an endovascular neovalve creation device, and a transcatheter-based venous valve replacement system remarkably close to being the next-generation armamentarium for treating PTS. The efficacy of current management alternatives for PTS remains limited. The experience gained over the last 50 years has propelled the development of novel prosthetic devices and endovascular systems in response to the unmet need for an effective PTS treatment. Early-phase results are promising and have granted the buildout of larger ongoing trials.