ABSTRACT
The postthrombotic syndrome (PTS) affects the deep venous system, and may also extend
to the superficial venous system of the legs in patients with a documented history
of deep vein thrombosis. Clinical symptoms of PTS may vary considerably and range
from scarcely visible skin changes to changes in pigmentation, pain, discomfort, venous
ectasia, edema, and ulceration. Our view based on standard investigations and the
proper place of advanced investigations regarding the etiology and pathophysiology
of PTS has lead to the Rotterdam approach, incorporating the evidence-based diagnostics
and treatments available for PTS. High-quality duplex sonography is mandatory in all
patients, providing anatomical and functional (reflux) information on both the deep
and superficial venous systems, and non- or partially recanalized veins (occlusion)
can also be detected using this technique. If the results of duplex sonography are
not clear or a venous desobstruction procedure is to take place, phlebography will
be the investigation of choice. There is a lot of evidence that medical elastic stockings
(MECS) are effective in the prevention of PTS with documented reflux, obstruction,
or both. When prescribing MECS, it is important to examine both elasticity and hysteresis
of the fabric of the stockings to apply the correct dynamic pressure for each individual
patient. Patients with documented PTS should receive life-long follow-up.
KEYWORDS
Postthrombotic syndrome - deep vein thrombosis - duplex sonography - phlebography
- elastic stockings - Rotterdam model
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Tim D WentelM.D.
Department of Dermatology and Venereology Erasmus MC
University Medical Center P.O. Box 2040 3000 CA Rotterdam, The Netherlands
eMail: t.wentel@erasmusmc.nl
