Understanding Post-thrombotic Syndrome (PTS)
Written by Dallas Vein Specialists on November 1, 2016
Postthrombotic (postphlebitic) syndrome (PTS) is a complication that occurs in nearly half of all patients with extensive deep vein thrombosis (DVT) in the leg. Because of its prevalence, it is important for patients with DVT to familiarize themselves with PTS, including symptoms and how to prevent it from developing. While it can be treated, there is no cure for PTS, hence the emphasis on prevention.
Cause of PTS
PTS may occur when a blood clot in a major leg vein, deep vein thrombosis or DVT, continues to obstruct the vein, or if it resolves, leaves the valves within the vein damaged and not functioning. Often there is a combination of residual clot and scarring within the vein, which results in some degree of obstruction of blood return from the leg, and damaged and non-functioning venous valves. This in turn leads to poor blood return and pooling in the leg veins. The result is permanent poor drainage and pooling that produces elevated pressure in the leg veins and a number of symptoms including pain, swelling and redness in the leg. As the condition worsens, the skin and soft tissues of the leg, usually in the lower calf, ankle and foot, deteriorate, begin to ooze fluid and typically heal slowly and incompletely if injured. Open sores that lead to chronic painful ulcerations are not unusual in such legs.
Prevention of PTS
The risk of developing PTS can be reduced after an episode of DVT by early diagnosis and medical attention. In the past, prevention consisted of prompt initiation of anticoagulant administration to stop the development of more clotting. Graduated compression stockings are also an effective treatment option for some cases of DVT. Now there are minimally invasive procedures that are done soon after the clotting event that actually rapidly dissolve the clot or remove it. Dissolving the clot involves administration of a thrombolytic agent that, over a short interval of time, actually breaks up and dissolves the clot. This is often done using a minimally invasive technique whereby a catheter is positioned in the vein and the thrombolytic (“clot busting”) agent is slowly dripped on to the clot. In other cases, the clot is actually removed by passing devices into the vein that break it up and remove it, again without surgery. These treatments are available in most large hospitals and are becoming invaluable in the early intervention for DVT. The goal here is to rapidly open the major vein and therefore reduce the risk of PTS.
Of course, the best way to prevent the complications of deep vein thrombosis is to prevent deep vein thrombosis in the first place. I have discussed in past articles ways to decrease DVT risk. These are available by clicking on “Dr. Whiddon’s Blogs” on the Dallas Vein Specialists web page. The importance of early treatment of DVT cannot be overemphasized, to prevent not only PTS but also progression of the clot, pulmonary embolism and even death.
Treatment of PTS
Patients who have been diagnosed with PTS should work with a vein specialist to determine the best treatment plan. Usual treatment involves some type of compression therapy such as wearing graduated compression hoses daily, which serve to reduce the elevated pressure in the leg veins. In cases of severe swelling, intermittent compression extremity pumps may be prescribed. At Dallas Vein Specialists, I have seen good results with these pumps when used once or twice daily. I also encourage patients with PTS to elevate their legs whenever possible to allow gravity to aid in drainage in addition to conscientiously using compression stockings daily.