II. Definitions
- Post-Thrombotic Syndrome (Post-Phlebitic Syndrome)
- Complication of Deep Vein Thrombosis (DVT) resulting in severe symptomatic Venous Insufficiency
- Symptoms include edema, pain, myalgias and may be further complicated by Venous Stasis Ulcers
III. Epidemiology
- Postthrombotic Syndrome is seen in 20 to 50% of patients with history of DVT
- Severe Postthrombotic Syndrome (e.g. Venous Stasis Ulcers) occurs in 5 to 10% of patients after DVT
IV. Pathophysiology
- Persistent venous Occlusion and valvular reflux result in increased venous pressures (venous Hypertension)
- Residual venous thrombus typically remains following DVT Anticoagulation
- Venous Hypertension results in Muscle hypoperfusion, decreased tissue integrity and increased permeability
- Leads to chronic inflammation-mediated edema
V. Risk Factors
- Anatomically extensive Deep Vein Thrombosis
- Recurrent Deep Vein Thrombosis on the same side
- Persistent extremity symptoms one month after the acute Deep Vein Thrombosis
- Older age (up to 3 fold increased risk)
- Obesity (BMI>30 doubles risk)
VI. Symptoms
- Characteristics
- Limb Pain
- Limb heaviness of Fatigue
- Limb swelling
- Provocative
- Standing
- Walking
- Palliative
- Rest
- Limb elevation
VII. Signs
- See Venous Insufficiency
- Acute Venous Insufficiency findings
-
Chronic Venous Insufficiency findings
- Telangiectasias (esp. peri-malleolar)
- New Varicose Veins
- Stasis Hyperpigmentation
- Lipodermatosclerosis (skin and subcutaneous tissue thickening)
- Venous Stasis Ulcers
VIII. Grading: Severity
IX. Management
- Bothersome Leg Edema is reduced with below knee graded Compression Stockings
- Encourage 30 minute walk per day
X. Prevention
- See Deep Vein Thrombosis Prevention
- Prevent the first DVT
- Prevent subsequent DVT
- Maximize compliance with Anticoagulation after DVT
- Avoid subtherapeutic INR with Warfarin (esp. in the first month after DVT diagnosis)
- Elastic Compression Socks (30-40 mmHg knee high) following lower extremity DVT
- May prevent Postthrombotic Syndrome with 30-40 mmHg knee high socks
- However mixed study results
- Berntsen (2016) Am J Med 129(4): 447 [PubMed]
- Kahn (2014) Lancet 383(9920): 880-8 [PubMed]
- Acute catheter directed Thrombolysis with or without thrombectomy
- Consider in acute proximal DVT (e.g. iliac vein or upper femoral vein)
- Lowers, but does eliminate risk of Post-Thrombotic Syndrome
- Enden (2012) Lancet 379(9810): 31-8 [PubMed]
- Watson (2014) Cochrane Database Syst Rev 1(1): CD002783 [PubMed]
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Related Studies
| 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 | ｼﾞｮｳﾐｬｸｴﾝｺﾞｼｮｳｺｳｸﾞﾝ, 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 | ｹｯｾﾝｺﾞｼｮｳｺｳｸﾞﾝ, 静脈うっ血, ｼﾞ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 |
