PTS is permanent damage to the veins caused by a thrombosis. This can be the case in both the upper and lower extremities. The latter are most frequently affected. If these thromboses are not recognized - or if treatment is unsuccessful - PTS can develop. This results in chronic blood stasis caused by scar tissue in the vessels.
This leads to damage to the venous valves, which is why the blood can no longer be properly drained from the parts of the body remote from the veins (usually the lower leg and foot). As a result, there is a nutritional disorder and thus damage to the skin and subcutaneous tissue, as well as a chronic tendency to swell and feelings of tension. 30 to 50 percent of patients who suffer or have suffered from thrombosis develop post-thrombotic syndrome.
The symptoms can be varied, depending on the extent of the vein damage. The main symptoms are a tendency to swell and increased water retention in the subcutaneous tissue: the medical term for this is oedema.
In addition, there is often a feeling of tightness in the arms or legs. A feeling of heaviness is also typical. Furthermore, skin discoloration is regularly observed, in particular a dark discoloration of the inside of the lower legs.
Water retention and varicose veins can also be symptoms of PTS. The varicose veins are caused by the fact that the blood has to flow through other channels due to the damaged vessels and also uses the superficial veins that are already visible from the outside. This then manifests itself in the formation of varicose veins.
If the vein damage progresses or remains untreated for a long time, it can also lead to the formation of a lower leg ulcer. This is also known as a leg ulcer among doctors. In common parlance, this is often referred to as an "open leg".
In contrast to the open leg in so-called arterial occlusive disease (where too little blood is pumped into the tissue due to narrowing of the arteries), the cause of PTS is the poor removal of blood and waste products. Wound healing is also restricted in this case and chronic wounds can develop and fail to heal or heal only with a delay.
Taking a medical history is often enough to make a suspected diagnosis of PTS. A previous thrombosis of the leg veins or increasing development of varicose veins is reported.
The typical physical examination findings, in particular skin changes in terms of discoloration and sores on the inside of the lower leg as well as visible varicose veins or spider veins, are also important indications of PTS.
If a thrombosis was previously present but the patient was not aware of it or it was not recognized, the diagnosis of PTS is not always easy. Sometimes it is only when a PTS is diagnosed that it becomes clear that the patient has suffered from a possibly unrecognized thrombosis.
There are various instrumental methods (i.e. using examination equipment) to diagnose PTS, including the possibility of an ultrasound examination. This is the simplest and quickest way to detect changes in the veins caused by PTS. In addition, an ultrasound examination can be repeated as often as required and regular checks, also known as follow-up checks, can be carried out.
X-ray imaging with contrast medium (known as phlebography) can also help to detect PTS. In this examination, both the typical bypass vessels and the venous valves can be clearly visualized. However, in contrast to sonography, this diagnostic method is being used less and less.
By Hellerhoff - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=8304911
As the main problem with PTS is the removal of blood from tissues remote from the body, treatment is aimed at supporting the return of blood. This is intended to prevent or reduce the pooling of blood in the tissue.
The most important measure to improve blood return is compression therapy. Various measures are available for this purpose. On the one hand, so-called compression bandages can be applied. This involves applying circular, stretchy bandages from bottom to top to build up pressure on the tissue, which improves the outflow of blood. However, it is important that the bandages are applied by qualified personnel and changed regularly. Otherwise, the pressure created by the bandages may be too high or too low. If the pressure is too high, circulation problems can occur, which can then also lead to an "open leg" or a feeling of coldness and pain in the lower leg or foot. If the pressure is too low, the symptoms of PTS are not successfully treated and the therapy is ineffective, so to speak.
In order to achieve a constant and reliable pressure effect, medical compression stockings (MCS) are therefore prescribed in most cases. These are specially made and prescription stockings of different lengths, which usually reach up to the knee or groin. There are different compression classes, depending on how much pressure is exerted on the tissue. Class 2 is most commonly used (medium pressure), while class 3 (high pressure) is prescribed for very pronounced findings and additional damage to the lymphatic system. Class 1 can be prescribed to high-risk patients in order to reduce the risk of thrombosis developing in stressful situations (e.g. prolonged sitting when traveling by car or plane, bed rest in the event of serious illness or after an operation).
In addition to compression, professional lymphatic drainage can also provide relief. This can help to stimulate the lymphatic system and reduce water 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 right treatment. This is particularly recommended for chronic wounds, as the right treatment with special wound cleansing and subsequent dressing changes can achieve healing in many cases.
