The Post-thrombotic Syndrome-Prevention and Treatment: VAS-European Independent Foundation in Angiology/Vascular Medicine Position Paper.

Authors

• Benilde Cosmi
• Agata Stanek
• Matja Kozak
• Paul W Wennberg
• Raghu Kolluri, OhioHealth
• Marc Righini
• Pavel Poredos
• Michael Lichtenberg
• Mariella Catalano
• Sergio De Marchi
• Katalin Farkas
• Paolo Gresele
• Peter Klein-Wegel
• Gianfranco Lessiani
• Peter Marschang
• Zsolt Pecsvarady
• Manlio Prior
• Attila Puskas
• Andrzej Szuba

Document Type

Article

Publication Title

Frontiers in Cardiovascular Medicine

Abstract

IMPORTANCE: The post-thrombotic syndrome (PTS) is the most common long-term complication of deep vein thrombosis (DVT), occurring in up to 40-50% of cases. There are limited evidence-based approaches for PTS clinical management.

OBJECTIVE: To provide an expert consensus for PTS diagnosis, prevention, and treatment.

EVIDENCE-REVIEW: MEDLINE, Cochrane Database review, and GOOGLE SCHOLAR were searched with the terms "post-thrombotic syndrome" and "post-phlebitic syndrome" used in titles and abstracts up to September 2020.

FILTERS WERE: English, Controlled Clinical Trial / Systematic Review / Meta-Analysis / Guideline. The relevant literature regarding PTS diagnosis, prevention and treatment was reviewed and summarized by the evidence synthesis team. On the basis of this review, a panel of 15 practicing angiology/vascular medicine specialists assessed the appropriateness of several items regarding PTS management on a Likert-9 point scale, according to the RAND/UCLA method, with a two-round modified Delphi method.

FINDINGS: The panelists rated the following as appropriate for diagnosis: 1-the Villalta scale; 2- pre-existing venous insufficiency evaluation; 3-assessment 3-6 months after diagnosis of iliofemoral or femoro-popliteal DVT, and afterwards periodically, according to a personalized schedule depending on the presence or absence of clinically relevant PTS. The items rated as appropriate for symptom relief and prevention were: 1- graduated compression stockings (GCS) or elastic bandages for symptomatic relief in acute DVT, either iliofemoral, popliteal or calf; 2-thigh-length GCS (30-40 mmHg at the ankle) after ilio-femoral DVT; 3- knee-length GCS (30-40 mmHg at the ankle) after popliteal DVT; 4-GCS for different length of times according to the severity of periodically assessed PTS; 5-catheter-directed thrombolysis, with or without mechanical thrombectomy, in patients with iliofemoral obstruction, severe symptoms, and low risk of bleeding. The items rated as appropriate for treatment were: 1- thigh-length GCS (30-40 mmHg at the ankle) after iliofemoral DVT; 2-compression therapy for ulcer treatment; 3- exercise training. The role of endovascular treatment (angioplasty and/or stenting) was rated as uncertain, but it could be considered for severe PTS only in case of stenosis or occlusion above the inguinal ligament, followed by oral anticoagulation.

CONCLUSIONS AND RELEVANCE: This position paper can help practicing clinicians in PTS management.

First Page

762443

Last Page

762443

DOI

10.3389/fcvm.2022.762443

Publication Date

2-24-2022

Recommended Citation

Cosmi B, Stanek A, Kozak M, Wennberg PW, Kolluri R, Righini M, Poredos P, Lichtenberg M, Catalano M, De Marchi S, Farkas K, Gresele P, Klein-Wegel P, Lessiani G, Marschang P, Pecsvarady Z, Prior M, Puskas A, Szuba A. The Post-thrombotic Syndrome-Prevention and Treatment: VAS-European Independent Foundation in Angiology/Vascular Medicine Position Paper. Front Cardiovasc Med. 2022 Feb 24;9:762443. doi: 10.3389/fcvm.2022.762443. PMID: 35282358; PMCID: PMC8907532.