[New advances in the knowledge on post-thrombotic syndrome]

Area of Science:

• Vascular Medicine and Surgery
• Hematology
• Medical Imaging

Context:

• Post-thrombotic syndrome (PTS) incidence remains uncertain, estimated between 17% and 50% one year after acute deep venous thrombosis (DVT) of the lower limbs.
• PTS is characterized by venous hypertension, valvular incompetence, and inflammatory reactions involving endothelial permeability, leukocyte adhesion, and tissue fibrosis.
• Risk factors for PTS are poorly understood, with recurrent DVT being the only identified factor to date.

Purpose:

• To review the current understanding of post-thrombotic syndrome (PTS) following deep venous thrombosis (DVT).
• To discuss diagnostic modalities, including clinical scales, Echo-Doppler, and emerging imaging techniques.
• To outline therapeutic strategies, encompassing pharmacological and surgical interventions.

Summary:

• Echo-Doppler is the primary non-invasive tool for diagnosing valvular dysfunction and chronic venous obstruction in PTS.
• Advanced imaging like CT, MR, and isotopic techniques show promise but require further validation.
• Phlebothropic drugs are the mainstay for non-surgical PTS management, while deep venous surgery is reserved for severe chronic venous insufficiency with significant reflux.

Impact:

• Improved diagnostic accuracy through advanced imaging may lead to earlier intervention.
• Optimized therapeutic strategies can mitigate the progression of chronic venous insufficiency and improve patient outcomes.
• Further research into PTS risk factors is needed to enhance preventative measures.