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Learn about post-thrombotic syndrome and how our vein clinic can help with treatment.

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What is post-thrombotic syndrome?

Post-thrombotic syndrome (PTS), also called post-phlebitic syndrome, occurs in 60 to 80 percent of people who have had a deep vein thrombosis (DVT). Symptoms usually start within 2 years of the instigating DVT, and may become severe and associated with leg ulcers in approximately 10 percent of cases.

PTS can have a very significant impact on your quality of life, both physically and psychologically. Over time, the discomfort and swelling of your legs may limit your ability to exercise and, eventually, may effect your ability to participate in your normal daily routine. Often, a significant impact is felt at work – especially in jobs where you are required to stand or sit for periods of time. And, the cost, in time lost at work as well as medical costs associated with treating the discomfort and progressive worsening of symptoms, is high. Once ulcers occur, the treatment of the ulcers and PTS is much more difficult, and the chances that the ulcer will recur (once it heals) is very high. If you are experiencing any of the below signs and symptoms of PTS, it is imperative that you come to our vein clinic in Mentor, OH for treatment as soon as possible.

Signs and symptoms of PTS in the leg may include:

  • 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

The symptoms may vary or progress over time, usually starting within the first 2 years after the DVT. In most cases, the symptoms worsen after walking, standing, or sitting for long periods of time. Walking or moving the legs and leg elevation usually help with the symptoms.

Risk factors for developing PTS after DVT:

  • Age
  • DVT in a proximal (upper part of) vessel
  • Repeated blood clots in the same leg
  • DVT that still has symptoms 1 month after treatment is started
  • Increased weight (obesity)
  • Inadequate anticoagulation (doses too low) during initial 3 months of treatment
  • Lack of appropriate use of properly fitted compression stockings for the first 2 years after DVT diagnosis

Diagnosis:

The diagnosis of PTS is based on having a prior history of DVT, clinical examination by your vein doctor, and your reported symptoms. At the Center for Advanced Vein Care, we pride ourselves on being thorough and treating our patients to the best of our ability, so you will also have an ultrasound exam looking at the deep veins for evidence of persistent blood clots, location of blood clots, any damage to the vessel and valves, and evidence of deep vein insufficiency (backward, or incorrect flow of blood within the vein). We will also evaluate the superficial vein systems for similar issues.

Prevention:
Prevention of PTS starts with preventing a DVT from occurring in the first place. Knowing your family history of previous DVTs or clotting disorders is important as sometimes, blood clots run in the family. If you know that a close family member has a history of blood clots, it is important to discuss this with your vein doctor at Center for Advanced Vein Care.

Whenever you are immobilized for long periods of time, meaning you are unable to move the muscles in your legs fully, you are at increased risk of blood clots. This is why you are at increased risk of blood clots if you have a long leg cast on, if you have a significant trauma or medical illness that requires prolonged bed rest, or if you travel a long distance in a confined space (for example, long flights). You can decrease your risk of blood clots in these scenarios by maintaining adequate hydration, walking and exercising your leg muscle regularly, and getting out of bed as soon as allowed when ill or hospitalized.

If you have had a blood clot, decreasing your risk of a second blood clot is essential. Your doctor may keep you on anticoagulation (blood thinners) beyond the typical initial treatment period, especially if you have a family history of or you, yourself, have a clotting disorder. Wearing compression stockings/socks and walking/moving as much as possible is very important. Also, weight loss, if you are overweight, is important, as excess weight may increase your risk of PTS.

Newer treatments for blood clots, especially the proximal clots that put you at higher risk for PTS, are becoming more available and seem to be helpful in preventing the development of PTS. Pharmacomechanical (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) are both being used to treat blood clots early, removing them before significant damage to the vein and its valves has a chance to occur. The important thing to know is that these vein treatments are most effective if the blood clot is ‘new’ – meaning it has just developed, ideally within the last 24 hours. The longer the clot has been there, the less effective these options are. Therefore, if you suspect you have developed a blood clot, it is pertinent to contact Center for Advanced Vein Care for prompt treatment.

Finally, the use of properly fitted compression stockings for the first two years after a DVT has been diagnosis is believed to decrease the risk of developing PTS.

If you have had a previous blood clot, especially if you have symptoms of PTS, it is important that you see a vein specialist for evaluation of PTS. Preventing the progression of PTS, prevention of the development of venous ulcers associated with PTS, and preserving your quality of life before further complications develop is our goal. Contact our vein clinic today for a free screening to ensure your veins enable you to live your best life.