Post Thrombotic Limb Syndrome

Post Thrombotic Limb Syndrome, PTS, can occur in up to half of patients who suffer a Deep Vein Thrombosis. It occurs because the DVT, and the process the body uses to clear the vein of clot, causes damage to the one-way valves inside the vein. Damage to these cause blood to pool at high pressure at the bottom of the leg leading to heaviness and swelling, and pain particularly during walking.

When a Specialist evaluates Post Thrombotic Syndrome it is important to assess whether the veins in the pelvis and thigh are open, to ensure that the scarring hasn't blocked off the veins to the leg. These can often be re-opened to relieve the pressure within the leg and relieve a significant portion of the symptoms. This would usually also require insertion of a metal stent to keep the vein open. 

Risks of PTS is more if the DVT was above the knee, if there has been more than one DVT in the same leg, if the patient if significantly overweight, or if the symptoms of the DVT persisted more than one month.

The diagnosis is made on the basis of the symptoms as they present, in combination with the history of previous DVT. The symptoms are some or all of the following;

• Chronic pain and swelling which is worse after prolonged standing and walking
• Heaviness in the legs with cramp, itching, tingling
• Painful red inflammation of the lower leg
• Chronic recurrent ulceration of the lower leg

It requires detailed assessment to ensure that there is only PTS causing the symptoms and that nothing else is the cause such as inadequate blood supply, that might be corrected to improve the symptoms. A Vascular Specialist will be able to make this detailed assessment.

Treatment is supportive using off the shelf or tailor-made pressure support garments (stockings or sleeves). There are some experimental treatments that attempt to transplant functioning valves from another part of the body to the affected part, and some artificial valves which can be implanted. Both of these techniques must be considered experimental, and cannot be recommended outside of an evaluated trial. Most people will manage well with supportive treatment only and armed with the advice and information provided by a Vascular Specialist.

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