Surgical and non-surgical approaches in the management of lower limb post-thrombotic syndrome. 2021

M Machin, and S Salim, and M Tan, and S Onida, and A H Davies, and J Shalhoub
Academic Section of Vascular Surgery, Department of Surgery & Cancer, Imperial College London, London, UK.

Introduction: Post-thrombotic syndrome (PTS) is a common lifelong condition affecting up to 50% of those suffering from deep vein thrombosis (DVT). PTS compromises function and quality of life with subsequent venous ulceration in up to 29% of those affected.Areas covered: A literature review of surgical and non-surgical approaches in the prevention and treatment of PTS was undertaken. Notable areas include the use of percutaneous endovenous interventions and the use of graduated compression stockings (GCS) after acute proximal DVT.Expert opinion: In patients with acute iliofemoral DVT, we think it is important to have a frank conversation with the patient about catheter-directed thrombolysis, aiming to reduce the severity of PTS experienced. We advocate ultrasound-accelerated thrombolysis with adjunctive procedures, such as deep venous stenting for proximal iliofemoral DVT. For patients with isolated femoral DVT, we believe that anticoagulation and GCS should be recommended. In patients with established PTS, we recommend GCS for symptomatic relief. We recommend that patients engage in regular exercise where possible with the prospect of gaining symptomatic relief. For those with severe PTS that has a significant effect on quality of life, we discuss the patient's case at a multi-disciplinary team meeting to plan for endovenous intervention.

UI MeSH Term Description Entries
D011788 Quality of Life A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral, social environment as well as health and disease. HRQOL,Health-Related Quality Of Life,Life Quality,Health Related Quality Of Life
D002406 Catheterization, Peripheral Insertion of a catheter into a peripheral artery, vein, or airway for diagnostic or therapeutic purposes. Arterial Catheterization, Peripheral,Catheterization, Bronchial,Catheterization, Peripheral Arterial,Catheterization, Peripheral Venous,Peripheral Catheterization,Venous Catheterization, Peripheral,Bronchial Catheterization,PICC Line Catheterization,PICC Line Placement,PICC Placement,Peripheral Arterial Catheterization,Peripheral Venous Catheterization,Peripherally Inserted Central Catheter Line Insertion,Arterial Catheterizations, Peripheral,Bronchial Catheterizations,Catheterization, PICC Line,Catheterizations, Bronchial,Catheterizations, PICC Line,Catheterizations, Peripheral,Catheterizations, Peripheral Arterial,Catheterizations, Peripheral Venous,PICC Line Catheterizations,PICC Line Placements,PICC Placements,Peripheral Arterial Catheterizations,Peripheral Catheterizations,Peripheral Venous Catheterizations,Placement, PICC,Placement, PICC Line,Placements, PICC,Placements, PICC Line,Venous Catheterizations, Peripheral
D005268 Femoral Vein The vein accompanying the femoral artery in the same sheath; it is a continuation of the popliteal vein and becomes the external iliac vein. Femoral Veins,Vein, Femoral,Veins, Femoral
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000208 Acute Disease Disease having a short and relatively severe course. Acute Diseases,Disease, Acute,Diseases, Acute
D015607 Stents Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. Stent
D015912 Thrombolytic Therapy Use of infusions of FIBRINOLYTIC AGENTS to destroy or dissolve thrombi in blood vessels or bypass grafts. Fibrinolytic Therapy,Thrombolysis, Therapeutic,Therapeutic Thrombolysis,Therapy, Fibrinolytic,Therapy, Thrombolytic,Fibrinolytic Therapies,Therapeutic Thrombolyses,Therapies, Fibrinolytic,Therapies, Thrombolytic,Thrombolyses, Therapeutic,Thrombolytic Therapies
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D054070 Postthrombotic Syndrome 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. Venous Stasis Syndrome,Syndrome, Postthrombotic,Syndrome, Venous Stasis
D020246 Venous Thrombosis The formation or presence of a blood clot (THROMBUS) within a vein. Deep Vein Thrombosis,Phlebothrombosis,Thrombosis, Deep Vein,Thrombosis, Venous,Deep Venous Thrombosis,Deep-Vein Thrombosis,Deep-Venous Thrombosis,Deep Vein Thromboses,Deep Venous Thromboses,Deep-Vein Thromboses,Deep-Venous Thromboses,Phlebothromboses,Thromboses, Deep Vein,Thromboses, Deep Venous,Thromboses, Deep-Vein,Thromboses, Deep-Venous,Thromboses, Venous,Thrombosis, Deep Venous,Thrombosis, Deep-Vein,Thrombosis, Deep-Venous,Vein Thromboses, Deep,Vein Thrombosis, Deep,Venous Thromboses,Venous Thromboses, Deep,Venous Thrombosis, Deep

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