II. Definitions

  1. Post-Thrombotic Syndrome (Post-Phlebitic Syndrome)
    1. Complication of Deep Vein Thrombosis (DVT) resulting in severe symptomatic Venous Insufficiency
    2. Symptoms include edema, pain, myalgias and may be further complicated by Venous Stasis Ulcers

III. Epidemiology

  1. Postthrombotic Syndrome is seen in 20 to 50% of patients with history of DVT
  2. Severe Postthrombotic Syndrome (e.g. Venous Stasis Ulcers) occurs in 5 to 10% of patients after DVT

IV. Pathophysiology

  1. Persistent venous Occlusion and valvular reflux result in increased venous pressures (venous Hypertension)
  2. Residual venous thrombus typically remains following DVT Anticoagulation

V. Risk Factors

  1. Anatomically extensive Deep Vein Thrombosis
  2. Recurrent Deep Vein Thrombosis on the same side
  3. Persistent extremity symptoms one month after the acute Deep Vein Thrombosis
  4. Older age (up to 3 fold increased risk)
  5. Obesity (BMI>30 doubles risk)

VI. Symptoms

  1. Characteristics
    1. Limb Pain
    2. Limb heaviness of Fatigue
    3. Limb swelling
  2. Provocative
    1. Standing
    2. Walking
  3. Palliative
    1. Rest
    2. Limb elevation

VII. Signs

  1. See Venous Insufficiency
  2. Acute Venous Insufficiency findings
    1. Limb Edema
    2. Limb Redness
    3. Limb dusky Cyanosis
  3. Chronic Venous Insufficiency findings
    1. Telangiectasias (esp. peri-malleolar)
    2. New Varicose Veins
    3. Stasis Hyperpigmentation
    4. Lipodermatosclerosis (skin and subcutaneous tissue thickening)
    5. Venous Stasis Ulcers

IX. Management

X. Prevention

  1. See Deep Vein Thrombosis Prevention
  2. Prevent the first DVT
  3. Prevent subsequent DVT
    1. Maximize compliance with Anticoagulation after DVT
    2. Avoid subtherapeutic INR with Warfarin (esp. in the first month after DVT diagnosis)
  4. Elastic Compression Socks (30-40 mmHg knee high) following lower extremity DVT
    1. May prevent Postthrombotic Syndrome with 30-40 mmHg knee high socks
    2. However mixed study results
    3. Berntsen (2016) Am J Med 129(4): 447 [PubMed]
    4. Kahn (2014) Lancet 383(9920): 880-8 [PubMed]
  5. Acute catheter directed Thrombolysis with or without thrombectomy
    1. Consider in acute proximal DVT (e.g. iliac vein or upper femoral vein)
    2. Lowers, but does eliminate risk of Post-Thrombotic Syndrome
    3. Enden (2012) Lancet 379(9810): 31-8 [PubMed]
    4. Watson (2014) Cochrane Database Syst Rev 1(1): CD002783 [PubMed]

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Related Studies

Ontology: Postphlebitic Syndrome (C0032807)

Definition (MSH) A condition characterized by a chronically swollen limb, often a leg with stasis dermatitis and ulcerations. This syndrome can appear soon after phlebitis or years later. Postphlebitic syndrome is the result of damaged or incompetent venous valves in the limbs. Distended, tortuous VARICOSE VEINS are usually present. Leg pain may occur after long period of standing.
Concepts Disease or Syndrome (T047)
MSH D011186
ICD9 459.1
ICD10 I87.0
SnomedCT 155460004, 20427003, 410013001
English Disease, Postphlebitic, Diseases, Postphlebitic, Postphlebitic Disease, Postphlebitic Diseases, Postphlebitic Syndrome, Postphlebitic Syndromes, Syndrome, Postphlebitic, Syndromes, Postphlebitic, POSTPHLEBITIC DIS, postphlebitic syndrome (diagnosis), postphlebitic syndrome, Postphlebitic Syndrome [Disease/Finding], post-phlebitic syndrome, phlebitic post syndrome, post phlebitic syndrome, Post phlebitic syndrome, Postphlebitic syndrome, Postphlebitic syndrome (disorder), postphlebitic; syndrome, syndrome; postphlebitic, Venous ulcer of leg syndrome, Post-phlebitic syndrome
Dutch postflebitissyndroom, postflebitisch syndroom, postflebitisch; syndroom, syndroom; postflebitisch, Post-flebitissyndroom, Syndroom, post-flebitis-
German postthrombotisches Syndrom, Postthrombotisches Syndrom, Postphlebitische Krankheit, Postphlebitisches Syndrom
Italian Sindrome postflebitica, Sindrome post-flebitica, Sindrome post flebitica, Malattia post flebitica, Malattia post-flebitica
Portuguese Síndrome pós-flebítica, Doença Pós-Flebítica, Síndrome Pós-Flebítica
Spanish Síndrome post-flebítico, Síndrome postflebítico, síndrome posflebítico, síndrome postflebítico (trastorno), síndrome postflebítico, Enfermedad Posflebítica, Síndrome Posflebítico
Swedish Postflebitiskt syndrom
Japanese ジョウミャクエンゴショウコウグン, 静脈炎後疾患, 静脈炎後症候群, 静脈炎後潰瘍
Czech postflebitický syndrom, Postflebitický syndrom
Finnish Posttromboottinen oireyhtymä
Russian POSTFLEBITICHESKII SINDROM, POSTFLEBITICHESKAIA IAZVA, ПОСТФЛЕБИТИЧЕСКАЯ ЯЗВА, ПОСТФЛЕБИТИЧЕСКИЙ СИНДРОМ
Korean 정맥염후 증후군
Polish Owrzodzenie pozapalne żył, Zespół pozapalny żył, Choroba żył pozapalna
Hungarian Postphlebitises syndroma, Postphlebitiszes syndroma
Norwegian Postflebittsyndrom
French Syndrome postphlébitique, Syndrome post-phlébitique, Séquelles de phlébite

Ontology: Postthrombotic Syndrome (C0277919)

Definition (MSH) A condition caused by one or more episodes of DEEP VEIN THROMBOSIS, usually the blood clots are lodged in the legs. Clinical features include EDEMA; PAIN; aching; heaviness; and MUSCLE CRAMP in the leg. When severe leg swelling leads to skin breakdown, it is called venous STASIS ULCER.
Concepts Pathologic Function (T046)
MSH D054070
ICD10 I87.009 , I87.0
SnomedCT 266336005, 71897006, 238788004
English VENOUS STASIS, Syndrome, Postthrombotic, Venous Stasis Syndrome, Syndrome, Venous Stasis, Postthrombotic Syndrome, Venostasis, Postthrombotic syndrome NOS, Postthrombotic syndrome, Postthrombotic Syndrome [Disease/Finding], post thrombotic syndrome, postthrombotic syndrome, venous stasis, Stasis;venous, stasis venous, venostasis, Stasis - venous, Post thrombotic syndrome, Venous stasis, Venous stasis syndrome, Venous stasis (finding), Venous stasis syndrome (disorder), stasis; venous, venous; stasis, Venous stasis, NOS
Japanese ケッセンゴショウコウグン, 静脈うっ血, ジョウミャクウッケツ, 血栓後症候群
Portuguese Síndrome Pós-Trombótica, ESTASE VENOSA, Venostase, Estase venosa, Síndrome pós-flebítica
Spanish Síndrome Postrombótico, Estasis venosa, Venostasis, síndrome de estasis venosa (trastorno), síndrome de estasis venosa, Síndrome postrombótico, estasis venoso (hallazgo), estasis venoso
Finnish Posttromboottinen oireyhtymä
French Syndrome de stase veineuse, SPT (Syndrome Post-Thrombotique), Syndrome post-thrombotique, STASE VEINEUSE, Stase veineuse, Saignée blanche pratiquée aux quatre membres à l'aide d'un garrot, Syndrome post-phlébitique
German Postthrombotisches Syndrom, Venostase, venoese Stase, postthrombotisches Syndrom
Russian ПОСТТРОМБОТИЧЕСКИЙ СИНДРОМ, POSTTROMBOTICHESKII SINDROM
Swedish Posttrombotiskt syndrom
Czech Posttrombotický syndrom, Venostáza, posttrombotický syndrom, potrombotický syndrom
Italian Stasi venosa, Sindrome post-trombotica, Sindrome post trombotica
Dutch venostase, veneuze stasis, stase; veneus, veneus; stase, posttrombotisch syndroom
Polish Zespół pozakrzepowy
Hungarian Postthrombotikus syndroma, Venás stasis, Venostasis
Norwegian Posttrombotisk syndrom