Diagnosis of PTS

The clinical picture of post thrombotic syndrome (PTS) is non-specific (1). Onset of symptoms may not be seen for 6-24 months after resolution of acute DVT symptoms (2).

The patient may complain of:

• aching pain, heaviness
• swelling
• pruritus
• paresthesia
• cramps

Physical examination may reveal:

• oedema
• hyperpigmentation
• redness
• peri-malleolar telangiectasiae
• lipodermatosclerosis - brawny, tender induration of the subcutaneous tissues of the medial lower limb
• secondary superficial varicose veins
• venous claudication - rare, seen in patients with persistent obstruction, a bursting pain in the leg occurs during exercise, may mimic arterial claudication (1,2)

Typically symptoms are aggravated by standing or walking and improve with resting, leg elevation and lying down (3).

Long term sequelae include development of venous hypertensive ulcerations:

• is chronic and indolent with a high recurrence rate once healing has been achieved
• often precipitated by minor trauma
• may not occur for 10-20 years after the initial DVT (1,2)

Further investigations are not necessary if signs and symptoms compatible with PTS develop in a patient with a history of a (documented or highly suspected) DVT. Diagnostic testing may be necessary in patients with leg complaints but without a likely or objectively proven previous DVT (1).

Reference:

• (1) Prandoni P, Kahn SR. Post-thrombotic syndrome: prevalence, prognostication and need for progress. Br J Haematol. 2009 May;145(3):286-95.
• (2) Institute for Clinical System Improvement (ICSI) 2011. Health Care Guidelines: Venous Thromboembolism Diagnosis and Treatment
• (3) Kahn SR. The post-thrombotic syndrome: progress and pitfalls. Br J Haematol. 2006 Aug;134(4):357-65