Compression therapy for postthrombotic syndrome

Abstract Use of compression therapy to reduce the incidence of postthrombotic syndrome among patients with deep venous thrombosis is a controversial subject and there is no consensus on use of elastic versus inelastic compression, or on the levels and duration of compression. Inelastic devices with a higher static stiffness index, combine relatively small and comfortable pressure at rest with pressure while standing strong enough to restore the “valve mechanism” generated by plantar flexion and dorsiflexion of the foot. Since the static stiffness index is dependent on the rigidity of the compression system and the muscle strength within the bandaged area, improvement of muscle mass with muscle-strengthening programs and endurance training should be encouraged. Therefore, in the acute phase of deep venous thrombosis events, anticoagulation combined with inelastic compression therapy can reduce the extension of the thrombus. Notwithstanding, prospective studies evaluating the effectiveness of inelastic therapy in deep venous thrombosis and post-thrombotic syndrome are needed.

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Reduced incidence of vein occlusion and postthrombotic syndrome after immediate compression for deep vein thrombosis

Blood ◽

10.1182/blood-2018-03-836783 ◽

2018 ◽

Vol 132 (21) ◽

pp. 2298-2304 ◽

Cited By ~ 18

Author(s):

Elham E. Amin ◽

Ingrid M. Bistervels ◽

Karina Meijer ◽

Lidwine W. Tick ◽

Saskia Middeldorp ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Compression Therapy ◽

Postthrombotic Syndrome ◽

Vein Thrombosis ◽

Vein Occlusion ◽

Absolute Reduction ◽

Key Points ◽

Deep Vein

Key Points Immediate compression therapy after DVT is associated with a 20% absolute reduction of RVO. The reduction of residual thrombosis is associated with an 8% absolute reduction of postthrombotic syndrome at 24 months.

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Open surgical treatment for postthrombotic syndrome

Phlebology The Journal of Venous Disease ◽

10.1177/0268355516633016 ◽

2016 ◽

Vol 31 (1_suppl) ◽

pp. 48-55 ◽

Cited By ~ 3

Author(s):

Christian-Alexander Behrendt ◽

Franziska Heidemann ◽

Henrik Christian Rieß ◽

Edgar Kleinspehn ◽

Tobias Kühme ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Surgical Techniques ◽

Venous Drainage ◽

Compression Therapy ◽

Postthrombotic Syndrome ◽

Vein Thrombosis ◽

Venous Valves ◽

Small Subgroup ◽

Open Surgical Treatment ◽

Deep Vein

The postthrombotic syndrome counts as a frequent long-term complication after deep vein thrombosis with approximately 20%–50% of affected patients after deep vein thrombosis. The earliest that diagnosis of postthrombotic syndrome can be made is 6 months after deep vein thrombosis. Most patients suffer from swelling and chronic pain. In all, 5%–10% of patients may even develop venous ulcers. The complex etiology consists of limited venous drainage because of chronic occlusions and secondary insufficiencies of venous valves inducing non-physiological venous reflux. Conservative management, first of all compression therapy, is of crucial importance in treatment of postthrombotic syndrome. Endovascular and open surgical techniques can additionally be used in a small subgroup of patients. Although rarely performed, this article illuminates the open surgical techniques in treatment of postthrombotic syndrome such as venous bypass surgery, valve repair and varicose vein surgery.

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On the Relationship between Changes in the Deep Veins Evaluated by Duplex Sonography and the Postthrombotic Syndrome 12 Years after Deep Vein Thrombosis

Thrombosis and Haemostasis ◽

10.1055/s-0038-1656121 ◽

1997 ◽

Vol 77 (06) ◽

pp. 1109-1112 ◽

Cited By ~ 41

Author(s):

U K Franzeck ◽

I Schalch ◽

A Bollinger

Keyword(s):

Femoral Vein ◽

Compression Therapy ◽

Venous Ulcer ◽

Duplex Sonography ◽

Clinical Findings ◽

High Rate ◽

Postthrombotic Syndrome ◽

Compression Stockings ◽

Acute Thrombosis ◽

Superficial Femoral Vein

SummaryIn a prospective study we performed color duplex ultrasonography to evaluate patency and valvular function of previous thrombosed veins 12 years after the acute thrombosis.Normal clinical findings were found in 64% of the patients, mild postthrombotic skin changes in 28%, and marked trophic changes in 5%; only 1 venous ulcer occurred.In 39 patients, 114 initially thrombosed vein segments were evaluated. Thirty-seven of 72 proximal segments were completely recanalized (23 with valvular incompetence) and 21 segments exhibited partial recanalization (19 with valvular incompetence). Superficial femoral vein segments were completely occluded in 19%, however, excellent collateralization was provided via the deep femoral vein. Thromboses of the posterior tibial vein demonstrated a high rate of recanalization with development of valvular incompetence in 52%.Whereas obstruction and valvular incompetence as single factors led to a postthrombotic leg in 8.5% and 33%, respectively, the most frequent cause for the development of the postthrombotic syndrome was the combination of reflux plus obstruction in the deep veins (50%).Compression therapy with elastic compression stockings is recommended for at least 5 years after the acute thrombosis.

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Foam sclerotherapy with Enoxaparin prophylaxis in high-risk patients with postthrombotic syndrome

VASA ◽

10.1024/0301-1526/a000247 ◽

2013 ◽

Vol 42 (1) ◽

pp. 50-55 ◽

Cited By ~ 4

Author(s):

Stefanie Reich-Schupke ◽

Martin Doerler ◽

Peter Altmeyer ◽

Markus Stücker

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Anticoagulation Therapy ◽

Compression Therapy ◽

Treatment Session ◽

Current Data ◽

Postthrombotic Syndrome ◽

Foam Sclerotherapy ◽

Symptomatic Pulmonary Embolism ◽

Risk Patients

Background: According to the current guidelines for sclerotherapy hypercoagulability and thrombophilia with or without deep venous thrombosis are seen as relative contraindication for this treatment. But often such patients have an indication for a sclerotherapy. Recommendations for additional anticoagulation for sclerotherapy are missing. Patients and methods: In this retrospective analysis (2009 - 2010), 54 patients with deep venous thrombosis and/or pulmonal embolism in their medical history that had had foam-sclerotherapy of truncal or tributary veins with Polidocanol 0.5 - 3 % without prior anticoagulation therapy were included. In addition to compression treatment (23 - 32 mmHg) for 3 weeks patients were treated with Enoxaparine 40 mg once a day for 3 days after sclerotherapy. Clinical and duplex controls were conducted before every treatment and 2 - 3 weeks after the last injection. Results: Sclerotherapy was done on one (30/54) or on both (24/54) legs. In 2/54 legs a truncal vein and in all patients tributaries were treated. The volume per treatment session averaged 3.3 ml foam (2 - 6 ml). The patients had undergone an average of 4.9 treatments (1 - 11); altogether 262 sessions. There were no cases of deep venous thrombosis or symptomatic pulmonary embolism. In 7/262 treatments (2.7 %) symptomatic localized phlebitis occurred and in 2/262 (0.8 %) patients an ascending phlebitis beyond the sclerotherapy region was observed. Conclusions: Based on current data, foam sclerotherapy can be regarded as safe in patients with anamnestic thromboembolism when co-treated with compression therapy (23 - 32 mmHg) and Enoxaparin 40 mg once per day for 3 days post sclerotherapy. The current study is the first with a standardized regime. In view of the limitations of this study there should be urther randomized controlled trials.

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How I treat postthrombotic syndrome

Blood ◽

10.1182/blood-2009-07-199174 ◽

2009 ◽

Vol 114 (21) ◽

pp. 4624-4631 ◽

Cited By ~ 101

Author(s):

Susan R. Kahn

Keyword(s):

Risk Factors ◽

Compression Therapy ◽

Postthrombotic Syndrome ◽

Compression Stockings ◽

Venous Ulceration ◽

Long Term Prognosis ◽

Socioeconomic Consequences

AbstractPostthrombotic syndrome (PTS) is a chronic complication of deep venous thrombosis (DVT) that reduces quality of life and has important socioeconomic consequences. More than one-third of patients with DVT will develop PTS, and 5% to 10% of patients will develop severe PTS, which may manifest as venous ulceration. The principal risk factors for PTS are persistent leg symptoms 1 month after the acute episode of DVT, extensive DVT, recurrent ipsilateral DVT, obesity, and older age. Daily use of elastic compression stockings (ECSs) for 2 years after proximal DVT appears to reduce the risk of PTS; however, there is uncertainty about optimal duration of use and compression strength of ECSs and the magnitude of their effect. The cornerstone of managing PTS is compression therapy, primarily using ECSs. Venoactive medications such as aescin and rutoside may provide short-term relief of PTS symptoms. The likelihood of developing PTS after DVT should be discussed with patients, and symptoms and signs of PTS should be monitored during clinical follow-up. Further studies to elucidate the pathophysiology of PTS, to identify clinical and biologic risk factors, and to test new preventive and therapeutic approaches to PTS are needed to ultimately improve the long-term prognosis of patients with DVT.

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Diagnosis and Treatment of Postthrombotic Syndrome

Hämostaseologie ◽

10.1055/a-1145-0108 ◽

2020 ◽

Vol 40 (02) ◽

pp. 214-220

Author(s):

Guido Bruning ◽

Jasmin Woitalla-Bruning ◽

Anne-Caroline Queisser ◽

Johanna Katharina Buhr

Keyword(s):

Varicose Veins ◽

Compression Therapy ◽

Postthrombotic Syndrome ◽

Venous Reflux ◽

Venous Valve ◽

Vein Thrombosis ◽

Venous Valves ◽

Fast Progression ◽

Secondary Healing ◽

Deep Vein

AbstractAfter acute treatment of deep vein thrombosis, not only the risk but also associated side effects of postthrombotic syndrome (PTS) are often underestimated.There are essentially two main types of PTS.1. Obstructive type—no sufficient recanalization of the deep vein.2. Refluctive type—sufficient recanalization of the deep vein, but insufficient venous valves in conjunction with venous reflux.A statement regarding deep vein recanalization and venous valve function can be made at the earliest after 6 months.PTS is often diagnosed without appropriate medical history. However, the assessment of the degree of recanalization and venous reflux is paramount to the medical prognosis. In our opinion, beside proximal thrombosis, sufficient recanalization combined with a strong venous reflux, especially in the popliteal vein, works as a powerful predictor for an unfavorable and fast progression of PTS and chronic venous insufficiency. Thus, the obstructive type is prognostically more favorable. For PTS in general, consistent compression therapy represents the first-line treatment option.With concomitant varicosis, one should assess whether the varicose veins represent primary varicosis with reflux or secondary varicosis without reflux. Especially in the presence of venous ulcers, the elimination of concomitant primary varicosis leads to an improved prognosis. Moist wound treatment is considered to be the standard treatment for all wounds undergoing secondary healing. A standardized set of topical therapeutic agents also facilitates the treatment. In individual cases “ulcershaving” and mesh graft transplantation proved to be successful.

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Compression Therapy in the Prevention of Postthrombotic Syndrome

Medicine ◽

10.1097/md.0000000000001318 ◽

2015 ◽

Vol 94 (31) ◽

pp. e1318 ◽

Cited By ~ 9

Author(s):

Hong-Tao Tie ◽

Ming-Zhu Luo ◽

Ming-Jing Luo ◽

Ke Li ◽

Qiang Li ◽

...

Keyword(s):

Compression Therapy ◽

Postthrombotic Syndrome

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Individually tailored duration of elastic compression therapy in relation to incidence of the postthrombotic syndrome

Journal of Vascular Surgery ◽

10.1016/j.jvs.2010.01.089 ◽

2010 ◽

Vol 52 (1) ◽

pp. 132-138 ◽

Cited By ~ 35

Author(s):

Arina J. ten Cate-Hoek ◽

Hugo ten Cate ◽

Jan Tordoir ◽

Karly Hamulyák ◽

Martin H. Prins

Keyword(s):

Compression Therapy ◽

Postthrombotic Syndrome ◽

Elastic Compression

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Lymphedema and lipedema - an overview of conservative treatment

VASA ◽

10.1024/0301-1526/a000115 ◽

2011 ◽

Vol 40 (4) ◽

pp. 271-279 ◽

Cited By ~ 21

Author(s):

Wagner

Keyword(s):

Conservative Treatment ◽

General Practitioners ◽

Subcutaneous Tissue ◽

Compression Therapy ◽

Compression Stocking ◽

Lymph Drainage ◽

Intensive Phase ◽

Manual Lymph Drainage ◽

Causal Therapy

Lymphedema and lipedema are chronic progressive disorders for which no causal therapy exists so far. Many general practitioners will rarely see these disorders with the consequence that diagnosis is often delayed. The pathophysiological basis is edematization of the tissues. Lymphedema involves an impairment of lymph drainage with resultant fluid build-up. Lipedema arises from an orthostatic predisposition to edema in pathologically increased subcutaneous tissue. Treatment includes complex physical decongestion by manual lymph drainage and absolutely uncompromising compression therapy whether it is by bandage in the intensive phase to reduce edema or with a flat knit compression stocking to maintain volume.

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