Insufficient Recanalization of Thrombotic Venous Occlusion-Risk for Postthrombotic Syndrome

To investigate the relationship between recanalization rate of occluded veins after deep venous thrombosis (DVT) and development of postthrombotic syndrome (PTS).

Patients treated for DVT of the lower limbs were evaluated 12-36 months after acute DVT. Of 100 patients, 34 developed PTS, defined as Villalta score of ≥ 5. Symptoms and signs of PTS were assessed, and ultrasound examination of the veins was performed, checking for residual thrombus and presence of reflux.

Patients with PTS were older (64.0 y vs 55.5 y; P = .007) and more frequently experienced recurrent DVT (15% vs 3%; P = .030). Patients with PTS had a lower rate of recanalization. Patients with residual thrombus appeared to be at increased risk for PTS development compared with patients with total recanalization (odds ratio 6.0; 95% confidence interval, 1.7-21.9; P = .006). No difference in the presence of reflux was observed.

Incomplete or absent recanalization is associated with a higher incidence of PTS, probably as a consequence of deteriorated blood flow and increased venous pressure. This suggests early recanalization could improve the outcome of DVT treatment in selected patients.