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Post thrombotic syndrome and venous leg ulcers

  • 05

    By Hratch L Karamanoukian MD FACS RVT RPhS RPVI DABVLM

    What is the incidence for developing deep vein thrombosis (DVT) in the U.S. population ?

    DVT affects 1 to 3 of 1000 people in the general population every year. 

    What per cent of patents who develop DVT develop post thrombotic syndrome ?

    Prospective studies with long-term follow-up (ie, ≥12 months) report that 20% - 50% of patients with DVT develop post thrombotic syndrome (PTS).

    What are other names for the post thrombotic syndrome (PTS) ?

    Post thrombotic syndrome is alse referred to as postphlebitic syndrome or secondary venous stasis syndrome,

    What is post thrombotic syndrome and its sequelae ?

    Post thrombotic syndrome is a specturm of clinical symptoms and signs related to chronic venous insusufficiency related to valvular damage in the deep veins following partial or complete healing of the deep venoud thrombus.

    As such, post thrombotic syndrome manifests as a result of the insufficient or leaky vein valves in the deep system and can vary from patient to patient, depending on the degree of valve damage. This can cause either: 

    1)  minor severe leg swelling at the end of the day, or

    2) intractable or severe swelling of the lower extremity 

    3) severe complications such as chronic debilitating lower-limb pain

    3) venous leg ulceration (chronic or recurrent) 

    When does post thrombotic syndrome occur ?

    In most cases, PTS develops within a few months to a few years after symptomatic deep vein thrombosis. 

    Can post thrombotic syndrome occur later than a few years after DVT ? 

    In one in 10 to one in 20 patients, post thrombotic syndrome can occur 10-20 years after DVT. 

    What per cent of patients with post thrombotic syndrome develop venous leg ulcers ? 

    One in 10 patients with post thrombotic syndrome patients can develop venous leg ulcers. 

    What is the probablity of developing venous leg ulcers in a patient with post thrombotic syndrome ? 

    1 in 20 patients with post thrombotic syndrome develop venous leg ulcers at 10 years. 

    Reference:  Kahn SR, Comerota AJ, Cushman M, Evans NS, Ginsberg JS, Goldenberg NA, Gupta DK, Prandoni P, Vedantham S, Walsh E and Weitz JL.  The postthrombotic syndrome: evidence-based prevention, diagnosis, and trestment strategies:  A scientific statement from teh American Heart Association. Circulation 2014; 130 (18); 1636-1661.