Postthrombotic Syndrome

Diagnosis of PTS is based on history and clinical presentation. The syndrome consists of signs and symptoms of heaviness, intolerance to exercises, pain, leg edema, paresthesia, cramps, and pruritus that may evolve to skin damage, such as hyperpigmentation, lipodermatosclerosis, and ulcers. PTS generates high expenses for government and insurance companies due to disability premiums, loss of labor force, and need for rehabilitation and wound care. Thus, prevention should be always contemplated to minimize the socioeconomic impact of the disease. DVT prophylaxis is mandatory in different settings such as major surgeries, critically ill patients, and those with significant risk factors for DVT. Surgical and endovascular procedures are indicated when deep venous reflux or obstruction is present with or without superficial vein involvement in patients with skin damage or disabling symptoms. Prior to the endovenous techniques, obstruction used to be treated with bypass grafts. Several open surgical techniques have been used to correct venous reflux reconstructing the valves. The main procedures described are internal or external (transcommissural) valvuloplasty, axillary vein transfer, vein transplantation, or valve transplantation. More recently, chronic venous obstruction is treated with balloon angioplasty and stenting. Compression therapy following an episode of proximal deep vein thrombosis has been advocated for decades by vascular specialists. However, the body of literature in this particular topic has not been considerably strong to make its recommendation evidence-based.