title: The postthrombotic syndrome: current evidence and future challenges.
abstract: Postthrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT) that develops in 20-50% of patients. PTS manifests as a spectrum of symptoms and signs of chronic venous insufficiency that can impose significant morbidity and have a negative impact on quality of life. Chronic venous hypertension caused by a combination of residual venous obstruction and valvular reflux is believed to play a major role in the pathophysiology of PTS. The Villalta scale is the most widely applied clinical scale used to diagnose and define PTS. Proximal DVT and recurrent ipsilateral DVT are the two principal established risk factors for PTS, and efforts in recent years have been focused on identifying a combination of clinical and biomarker predictors that will define high-risk patients and possibly new therapeutic targets. The best way to prevent PTS is to prevent the occurrence of DVT, and to provide optimal anticoagulation for the acute phase of DVT once it occurs. Recent years have brought progress in our understanding of the role of endovascular techniques in the prevention and treatment of PTS and the subgroups of patients that may benefit from these modalities. Pharmacomechanical catheter-directed thrombolysis is the most promising interventional modality for prevention of PTS. This review summarizes the current state of evidence on PTS of the lower limbs, and highlights areas where uncertainty still exists that require further research.
authors.affiliation: Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Rabinovich
authors.affiliation: Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada.|Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.|Division of Internal Medicine and Department of Medicine, McGill University, Montreal, Canada.
authors.forename: S R
authors.initials: SR
authors.lastname: Kahn
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D002986:Clinical Trials as Topic; D057510:Endovascular Procedures; D006801:Humans; D054070:Postthrombotic Syndrome / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D015912:Thrombolytic Therapy; D014689:Venous Insufficiency; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000517:prevention & control / Q000628:therapy
chemical_list: D015415:Biomarkers
keywords: compression stockings; postthrombotic syndrome; risk factors; thrombolytic therapy; venous thrombosis