title: The Treatment of Post-Thrombotic Syndrome.
abstract: BACKGROUND
  Post-thrombotic syndrome (PTS) arises in 20-50% of patients who have sustained a deep vein thrombosis and markedly impairs their quality of life.
  
  
  METHODS
  This review is based on pertinent publications retrieved by a selective literature search in PubMed and the Cochrane Library, and on the guidelines of the German Societies of Phlebology and Vascular Surgery (Deutsche Gesellschaft für Phlebologie, Deutsche Gesellschaft für Gefässchirurgie).
  
  
  RESULTS
  The treatment options are conservative treatment with compression and patient exercises, endovascular recanalization with stent angioplasty, and open bypass surgery of the iliac obstructions. The endovascular techniques yield patency rates of 73 to 100%, with thrombotic stent occlusion and hematoma as potential complications. The open operations have only been documented in studies with small case numbers (3 to 85 cases per study, patency rates 58 to 100%). The complications of these invasive procedures can include thrombotic bypass occlusion, hematoma, and wound infection. There have been randomized trials of conservative treatment, but not of surgical treatment. The American Heart Association, in its guidelines, gives the same weak recommendation for all surgical methods (IIb).
  
  
  CONCLUSIONS
  All conservative options should be exhausted as the first line of treatment. If PTS symptoms persist and markedly impair the patient's quality of life, the possible indication for surgery should be considered. As PTS hardly ever leads to death or limb loss, its treatment should be as uninvasive as possible. Endovascular recanalization is an attractive option in this respect. A conclusive evaluation of the role of endovascular procedures in PTS must await randomized trials of this form of treatment and of the optimal stent configuration.
authors.affiliation: University Hospital Aachen.
authors.forename: Karina
authors.initials: K
authors.lastname: Schleimer
authors.forename: Mohammad Esmaeil
authors.initials: ME
authors.lastname: Barbati
authors.forename: Alexander
authors.initials: A
authors.lastname: Gombert
authors.forename: Volker
authors.initials: V
authors.lastname: Wienert
authors.forename: Jochen
authors.initials: J
authors.lastname: Grommes
authors.forename: Houman
authors.initials: H
authors.lastname: Jalaie
mesh_terms: D057510:Endovascular Procedures; D006801:Humans; D011183:Postoperative Complications; D054070:Postthrombotic Syndrome / Q000628:therapy*; D011788:Quality of Life; D015607:Stents; D016896:Treatment Outcome; D020246:Venous Thrombosis