Venous thrombosis

Abstract

Venous thrombosis occurs commonly in the deep veins of the lower limb (DVT) and can result in pulmonary embolus (PE). Venous thromboembolism is the most common cause of death in hospitalized patients. It also represents a significant cost burden. The most common chronic complication of DVT is the post thrombotic syndrome (PTS). Manifestations of PTS can range from mild to severely debilitating. Patients report pain, swelling, and fatigue that is aggravated by walking or standing and improves with rest and elevation. It is a clinical diagnosis and while there is no gold standard diagnostic test, it is generally diagnosed using validated scoring systems; however, these all have shortcomings. PTS develops due to venous hypertension. The mechanism behind this is persistent obstruction and valvular reflux. Risk factors for PTS include a proximal DVT, previous ipsilateral DVT, pre-existing venous insufficiency, elevated Body Mass Index (BMI), increasing age and subtherapeutic anticoagulation. The principles of preventing PTS are DVT prophylaxis, thrombolysis of acute thrombus, and therapeutic anticoagulation. Early thrombus removal is indicated in emergent scenarios or where symptoms are not responding to treatment and may have benefit in the prevention of the development of moderate/severe PTS. Open deep venous surgery has largely been superseded by endovascular approaches. Adjunctive deep venous stenting is an exciting and developing area for the management of these patients.