Postthrombotic Syndrome - Find a Specialist and Get Information

PTS is permanent damage to the veins caused by a thrombosis. This can occur in both the upper and lower extremities. The lower extremities are most commonly affected. If these thromboses go undiagnosed—or if treatment is unsuccessful—PTS can develop. This leads to chronic blood stasis caused by scar tissue in the veins.

This damages the venous valves, preventing blood from being properly drained from the distal tissues (usually the lower leg and foot). As a result, blood supply is impaired, leading to damage to the skin and subcutaneous tissue, as well as a chronic tendency toward swelling and a feeling of tightness. Between 30 and 50 percent of patients who have or have had a thrombosis develop post-thrombotic syndrome.

The symptoms can vary widely, depending on the severity of the venous damage. The primary symptoms are a tendency toward swelling and increased fluid retention in the subcutaneous tissue—the medical term for this is edema. 

In addition, pulling pains in the arms or legs often occur. A feeling of heaviness is also typical. Furthermore, skin discoloration is commonly observed, particularly dark discoloration on the inner sides of the lower legs.

Fluid retention and varicose veins can also be symptoms of PTS. Varicose veins develop because, due to damaged blood vessels, blood must flow through alternative pathways and, as a result, also uses the superficial veins that are already visible from the outside. This manifests as the formation of varicose veins.

If the venous damage progresses or remains untreated for an extended period, a lower-leg ulcer may also develop. This is also known among medical professionals as an “ulcus cruris.” Colloquially, it is often referred to as an “open leg.”

In contrast to an open leg caused by so-called peripheral arterial disease (where insufficient blood is pumped into the tissue due to narrowing of the arteries), the cause of PTS lies in the poor drainage of blood and waste products. Here, too, wound healing is impaired, and chronic wounds can develop that do not heal or heal only slowly.

Often, taking a medical history (anamnesis) is sufficient to make a suspected diagnosis of PTS. A history of leg vein thrombosis or the progressive development of varicose veins is reported.

Typical physical examination findings—particularly skin changes such as discoloration and wounds on the inner side of the lower leg, as well as visible varicose veins or spider veins—are also important indicators of PTS.

If thrombosis was present previously but was unknown to the patient or went unrecognized, diagnosing PTS is not always easy. Sometimes it is only through the diagnosis of PTS that it becomes clear the patient had suffered from a potentially undiagnosed thrombosis in the first place.

There are various diagnostic methods (i.e., using medical devices) to detect PTS. One option is an ultrasound examination. This is the simplest and fastest way to detect changes in the veins caused by PTS. In addition, an ultrasound examination can be repeated as often as needed to perform regular follow-ups, also known as monitoring.

An X-ray examination using contrast dye (known as phlebography) can also help detect PTS. This examination clearly visualizes both the typical collateral vessels and the venous valves. However, unlike ultrasound, this diagnostic method is being used less and less frequently.

Von Hellerhoff – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=8304911

Since the main problem with PTS is the drainage of blood from tissues distal to the heart, treatment aims to support the return of blood. This is intended to prevent or reduce the pooling of blood in the tissues. 

The most important measure for improving venous return is compression therapy. Various methods are available for this purpose. First, so-called compression bandages can be applied. In this method, pressure is applied to the tissue using elastic bandages wrapped in a circular pattern from the bottom up, which improves blood outflow. It is important, however, that the bandages are applied by trained personnel and changed regularly. Otherwise, the pressure created by the bandages may be too high or too low. If the pressure is too high, circulatory problems can develop, which in turn can also lead to an “open leg” or a sensation of coldness and pain in the lower leg or foot. If the pressure is too low, the symptoms of PTS are not effectively treated, and the therapy is, so to speak, ineffective.

To achieve a consistent and reliable compressive effect, medical compression stockings (MCS) are therefore prescribed in most cases. These are custom-made, prescription-only stockings of varying lengths, which usually extend to the knee or the groin. There are different compression classes, depending on the intensity of the pressure applied to the tissue. Class 2 (medium compression) is used most frequently; Class 3 (high compression) is prescribed for very severe cases and additional damage to the lymphatic system. Class 1 stockings may be prescribed for at-risk patients to reduce the risk of thrombosis during situations involving prolonged inactivity (such as sitting for long periods during a car or plane trip, bed rest due to a serious illness, or after surgery). 

In addition to compression, professionally performed lymphatic drainage can also provide relief. This can help stimulate the lymphatic system and reduce fluid retention. Anyone suffering from PTS should definitely consult a specialist—such as a vascular surgeon or phlebologist. They can interpret the symptoms, make a diagnosis, and initiate the appropriate treatment. This is particularly recommended for chronic wounds, as proper treatment—including specialized wound cleansing and subsequent dressing changes—can lead to healing in many cases.