Deep Vein Thrombosis and Post-Thrombotic Syndrome

Deep Vein Thrombosis and Post-Thrombotic Syndrome

The post-thrombotic syndrome (PTS) is an important chronic complication of deep vein thrombosis (DVT). Another condition known as chronic venous insufficiency (CVI) may develop following a PTS, which in some cases can be the cause for the onset of lymphedema.

To better understand the mechanics of these conditions, a brief discussion of the cardiovascular system is necessary:

The cardiovascular system is an elaborate network designed

to deliver oxygen and nutrients to body organs and to remove waste products of

metabolism from the tissues. Its main components are the heart and a system of vessels

that transports blood throughout the body. The systemic circulation is the portion of the

cardiovascular system which transports oxygenated (arterial) blood away from the heart, to

the rest of the body, and returns oxygen-depleted (venous) blood back to the heart.

On its way back to the heart, the venous blood passes from capillaries and small veins

through progressively larger veins and connects with the right atrium of the heart via the

superior and inferior vena cava.

Theblood pressure inside the thin walled veins is considerably lower than thepressure in the arteries. A system of valves inside the larger veins preventspooling of venous blood in the lower extremities and helps to ensuretransporting the venous blood back to the heart efficiently. In fact, thepressure in the venous system is so low that a sufficient return of blood tothe heart would not be possible without the help of the muscle and joint pumps,diaphragmatic breathing and the suction effect of the heart during therelaxation phase or diastole. Together with a functioning valvular system intheveins, these supporting mechanismspropel the venous blood back to the heart.

Deep venous thrombosis is caused by ablood clot (thrombus) that forms in the deep veins of the body, mostly in thelegs; however, blood clots can form in the deep veins of the upper extremitiesas well. Blood clots can cause an obstruction of the return of venous bloodfrom the extremities and form as a result of something slowing or changing theflow of blood in the veins.

Risk factors for thrombosis include:

●       Long-termbed rest

●       Crossingthe legs for long periods of time when sitting, or sitting for long periods oftime, such as in a plane or car

●       Duringand after pregnancy

●       Nothaving enough water in the body (dehydration)

●       Takingbirth control pills or estrogen hormones

●       Usingan intravenous catheter long-term

●       Fracturesin the pelvis or legs

●       Obesity

●       Recentsurgery (most commonly hip, knee, or female pelvic surgery)

Embolism is a condition that candevelop when a clot breaks off and moves through the bloodstream. A blood clotcan get stuck in the brain, lungs, heart, or other area, and can lead to severedamage.

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Post-thrombotic syndrome (PTS) – alsoknown as post-phlebitic syndrome or venous stress disorder – is an importantlong-term complication of deep vein thrombosis (DVT) and can develop in more thanone third (1) of patients who experience a deep vein thrombosis in the leg. PTSis caused by damage to the veins resulting from the DVT. As a result ofincompetent valves and/or persistent venous obstruction from the thrombus, thefluid dynamics inside the veins change and pressure inside the venous vesselsincreases. Increased pressure causes the symptoms typically associated withPTS, such as pain, swelling and redness of the lower leg (which can be worseafter walking or standing for a long time and better after resting or raisingthe leg).

What can be done to preventpost-thrombotic syndrome?

The best way to avoid PTS is toprevent a blood clot from forming in the first place. Some individuals have ahigher risk of developing blood clots, especially patients in the hospital whohave had recent surgery or are confined to bed. These patients are givencompression boots and stockings to prevent blood clotsfrom forming. Medication to prevent the formation of a thrombus in high-riskhospitalized patients is often used and will prevent some cases of PTS (4).

These and other individuals whoexperience symptoms of PTS greatly benefit from frequent elevation of the legs,exercise and the use of compression stockings, which prevent the venous bloodfrom pooling. Studies have shown that elastic stockings are well tolerated andthat their use reduces the overall incidence of the post-thrombotic syndromefrom 49% to 26% and the overall incidence of severe forms of PTS from 12% to3.5% (5).

Severe and chronic swelling, chronicpain varicose veins and venous ulcerations are symptoms that can develop inlong standing PTS – 5% – 10% of patients with deep vein thrombosis may developthis severe form of PTS (2).

Failure to effectively combat thesymptoms of post-thrombotic syndrome can lead to chronic venous insufficiencies(CVI), which in turn may develop into lymphedema.

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