Post-Thrombotic Syndrome: Pathophysiology, Clinical Implications, and Advances in Management

Post-thrombotic syndrome (PTS) is a common and challenging complication of deep vein thrombosis (DVT). PTS is characterized by chronic venous insufficiency and persistent venous hypertension. Clinical features are nonspecific. Despite its high prevalence, PTS lacks standardized diagnostic criteria. Furthermore, PTS carries significant morbidity and puts a burden on the healthcare system, as the condition is irreversible and management options tend to be limited. Herein, we review the current literature on PTS regarding pathophysiology, diagnosis, and management.

Articles regarding post-thrombotic syndrome (PTS) were searched via PubMed, Embase, and Google Scholar between January 1980 and January 2025 using relevant keywords. Studies and reports written in languages other than English, for pediatric patients, and related to other venous disorders were excluded. Selected articles were reviewed in detail, and principal findings and outcomes of the studies were critically analyzed and summarized.

While diagnosis is largely clinical, scales such as the Villalta scale and CEAP classification provide tools for objective evaluation with limited accuracy and reliability. Current treatment options for PTS include targeted lifestyle modification, pharmacologic treatment, compression therapy, proper and timely anticoagulation, and interventions such as thrombolysis, thrombectomy, and stenting. Evidence is limited for compression therapy (stockings) currently; however, catheter-directed interventions have stronger evidence of efficacy with several limitations in prevention and treatments.

Overall, there is no definitive method to either entirely prevent PTS or effectively treat it once it is established. Preventing DVT remains the cornerstone of reducing PTS incidence. This review highlights the urgent need for comprehensive prevention strategies, improved diagnostic tools, and evidence-based treatment protocols. Further research is essential to bridge the existing knowledge gaps, optimize patient outcomes, and develop effective approaches to both prevention and management.