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Postthrombotic syndrome: surgical possibilities.

Ajay K Khanna¹, Shivanshu Singh

¹Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India.

|November 16, 2011

Summary

Postthrombotic syndrome (PTS) management is improving with new surgical and endovascular treatments. Early intervention can reduce leg ulceration and enhance patient quality of life.

Area of Science:

Vascular Surgery
Interventional Radiology

Background:

Postthrombotic syndrome (PTS) is a chronic leg complication following deep vein thrombosis (DVT).
It presents with pain, swelling, skin changes, and potential ulceration due to venous outflow obstruction and reflux.
Current management focuses on symptom relief, but newer interventions offer promising outcomes.

Purpose of the Study:

To review the role of modern surgical and endovascular interventions in managing PTS.
To highlight the importance of early intervention in selected patients.

Main Methods:

Assessment of venous obstruction and reflux using duplex ultrasound, IVUS, and venography.
Surgical and endovascular techniques including stenting, endophlebectomy, bypass, ablation, valvuloplasty, and vein transposition.

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Main Results:

Venous obstruction requires earlier intervention than reflux.
Endovenous stenting, endophlebectomy, and bypass address obstruction.
Superficial reflux is managed with ablation techniques.
Valvuloplasty and vein transposition address deep venous valve issues.

Conclusions:

Early surgical or endovascular interventions in PTS patients can decrease recurrent ulceration and skin changes.
These interventions significantly improve the quality of life for individuals with PTS.