Title:Management of Post-thrombotic Syndrome: A Comprehensive Review
Volume: 28
Issue: 7
Author(s): Nikolaos Chaitidis*, Damianos G. Kokkinidis, Zoi Papadopoulou, Natasha Hasemaki, Robert Attaran and Christos Bakoyiannis
Affiliation:
- Department of Medicine, Hellenic Army Medical Corps, Argos Orestikon, Kastoria 52200, Greece
Keywords:
Post-thrombotic syndrome, chronic venous thrombotic obstruction, deep reflux, compression, phlebotonics, sulodexide, pentoxifylline, venous bypass, venoplasty.
Abstract:
Background: Post-thrombotic syndrome (PTS) is the most common long-term complication of acute
deep venous thrombosis (DVT). The cumulative incidence of PTS in the first two years after the first acute
DVT diagnosis approximates 25%.
Objective: This study aims to summarize the most recent updates and provide a comprehensive review of the
current management of PTS.
Methods: We searched MEDLINE/PMC/NCBI Bookshelf (PubMed), Cochrane, Embase, Scopus, ClinicalTrials,
and OpenGrey databases for relevant articles in English published from the establishment of each separate
database until February 9, 2021.
Conclusion: PTS constitutes the most frequent long-term complication of lower limb deep venous thrombosis
(DVT). Lifestyle changes and compression treatment represent an integral part of PTS management and have a
clear benefit to offer in PTS patients. Pharmacological treatment with phlebotonic and non-phlebotonic medications,
such as micronized purified flavonoid fraction (MMPF) and sulodexide, respectively, may have a more
central and significant role in PTS management than previously thought. The introduction of percutaneous
transluminal venoplasty (PTV) and stenting has again raised our expectations with the field, along with new
concerns and considerations. There is a growing number of studies that report promising results on patientoriented
outcomes on PTS patients who were treated with PTV and stenting. Moreover, hybrid (endovascular/
surgical) interventions may also represent a safe and efficacious treatment option for a subset of patients with
PTS. Patient selection criteria for endovascular and hybrid interventional treatment should be carefully set and
standardized. Post-operative care after venoplasty is an important field of future research with potential clinical
impact. Management of deep and superficial reflux remains controversial. Hopefully, future prospective studies
shall provide more robust evidence on the management of PTS.
