Post Thrombotic Syndrome

Post-Thrombotic Syndrome (PTS) is a medical condition that occurs in 60 – 80 percent of people who have previously experienced a Deep vein thrombosis (DVT). The condition is also commonly referred to as post-phlebitic syndrome. Symptoms associated with PTS typically begin to develop within 2 years of the original offending DVT. The condition normally will continue to worsen in severity until which time in up to 10 percent of sufferers, it will manifest into venous stasis leg ulcers.

PTS can undoubtedly significantly impact a person’s overall quality of life, both physically and psychologically. As PTS progresses in severity over time, symptoms often evolve from a mild swelling and discomfort to rather significant swelling and discomfort that just will not resolve despite all mitigation attempts. Eventually the symptoms will worsen to a level that begins to limit the person’s ability to participate in even normal daily activities. Such an impact on a person’s activities is typically gradual in onset. It is most often first felt at work especially in professions that require prolonged sitting or standing. Conditions like PTS, when left unaddressed, can have an enormous economic cost as well when considering the potential for lost work hours and the cost of medical treatments required to combat the gradually worsening symptoms commonly associated with PTS. The progressive nature of this medical condition, especially if left untreated, results in a condition for which there is no cure. PTS related venous ulcers, for instance, require extensive treatment and are very difficult to treat and retain a high risk of recurrence even when healed. If you have a history of DVT and are beginning to notice some of the signs and symptoms of PTS noted below, it is critical that you call our office at 314.842.1441 to set up a free consultation with our team of vein specialists as soon as possible.

Signs and symptoms of PTS

  • pain (aching or cramping)
  • heaviness
  • itching
  • swelling
  • varicose veins (bulging varicosities)
  • skin color changes (brownish or reddish discoloration on the skin or ankle)
  • leg ulcers

PTS symptoms vary between people and worsen over time. Most people report that they first started to notice symptoms in their legs 2 or more years after having had a DVT. For many, their symptoms are exacerbated by anything that requires prolonged sitting or standing. In contrast, many people report that any activities that increase leg movement or allow for elevation of the legs, typically help to decrease the severity of the symptoms.

Risk Factors

  • Age
  • Increased weight (obesity)
  • History of multiple blood clots
  • A history of a DVT in the upper part of the leg
  • History of suboptimal anticoagulation treatment following DVT diagnosis
  • Failure to wear properly fitting graduated compression stockings after DVT diagnosis
  • History of persistent DVT symptoms despite anticoagulation treatment

Diagnosis

The diagnosis of PTS is often made based on patient history, clinical exam, and reported symptomatology. At STL Vein & Cosmetics, our dedicated staff of vein experts will thoroughly assess every individual case to determine whether PTS is a problem. Any initial consultation for PTS requires an ultrasound evaluation in order to thoroughly assess the quality of venous blood flow within the superficial and deep venous systems. The presence of or lack of venous flow abnormalities will help our staff determine whether your medical issues merit a diagnosis of PTS.

Prevention

Prevention of PTS can be difficult initially due to the fact that PTS is normally secondary to a prior history of a Deep vein thrombosis (DVT). That being said, initial attempts at preventing the development of PTS would in reality need to begin with DVT prevention. Unfortunately, not all cases of DVT can be prevented or even anticipated. Knowing one’s family history can be a great starting point for many in that a family history of DVT’s or blood clotting disorders can help guide physicians in the care and management of the patient.

It is also important to keep in mind that one of the most common cause of DVT is a prolonged period of immobilization. A lack of movement, whether intentional or unintentional, results in a decrease in blood flow within the legs. Stagnant blood increases your risk of developing a blood clot. This is why a person’s blood clot risk increases with prolonged bed rest, leg cast use, and long-distance airplane flights. All of these situations share one common trait. They all lead to long periods of immobilization of the leg(s). You can decrease your risk of blood clots in these scenarios by moving about whenever possible to help your body maintain adequate blood flow.

If you already have a history of a prior DVT, the goal in prevention of PTS now involves preventing the development of a second DVT. This means completing the initial treatment of anticoagulation medications prescribed by your physician, and then trying to determine what caused the initial DVT in the first place. It is this initial cause that will determine the next step in the physician’s management and prevention of a second DVT. Your next step may involve long term anticoagulation medications (blood thinners) in order to combat an underlying clotting disorder or it may be necessary for you to wear compression stockings. The experts at STL Vein & Cosmetics can help you navigate these issues.

Treatment

The primary goal in the treatment of PTS is to prevent its development in the first place. This prevention begins the moment a person is diagnosed with a DVT. Not all DVT’s are created equal. The location of the DVT plays an important role in determining the overall risk of developing PTS down the road. For instance, proximal blood clots in the leg have been shown to increase a person’s risk of developing PTS in the future. Fortunately, there are new treatment modalities that are now available. Some of these treatments have even been shown preliminarily to be beneficial in the prevention of PTS. A couple of these new treatment options include pharma-mechanical (medication AND mechanical) thrombolysis (breaking up of the clot), and catheter-directed thrombolysis (the medication is injected through a catheter directly to the site of the clot). Both have been shown to be effective in the treatment of newly developed DVT.  The longer the clot has been there, normally greater than 24 hrs, the less effective these options become. This is one of the reasons why it is so important to diagnose and treat DVT’s as quickly as possible. The longer a DVT is allowed to remain, the greater the likelihood of the blood clot damaging the valves within the lumen of the affected vein. It is this damage that is believed to be a primary cause of PTS development down the road.

Finally, medical science has shown that after a DVT, the use of properly fitted compression stockings for the first two years is beneficial in decreasing a person’s risk of developing PTS.

If you have a history of a DVT and are beginning to notice that your leg is beginning to have symptoms of PTS, call our dedicated team of experts at STL Vein & Cosmetics. Let us help you guide you in managing your PTS while also preserving your quality of life before your PTS progresses to a point of no return. Call us today at 314.842.1441 and set up your free consultation. We are here to help!

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