The Post-thrombotic Syndrome-Prevention and Treatment: VAS-European Independent Foundation in Angiology/Vascular Medicine Position Paper
ImportanceThe post-thrombotic syndrome (PTS) is the most common long-term complication of deep vein thrombosis (DVT), occurring in up to 40–50% of cases. There are limited evidence-based approaches for PTS clinical management.ObjectiveTo provide an expert consensus for PTS diagnosis, prevention, and...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-02-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.762443/full |
| _version_ | 1818330976960380928 |
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| author | Benilde Cosmi Benilde Cosmi Agata Stanek Matja Kozak Paul W. Wennberg Raghu Kolluri Marc Righini Pavel Poredos Michael Lichtenberg Mariella Catalano Sergio De Marchi Sergio De Marchi Katalin Farkas Paolo Gresele Peter Klein-Wegel Gianfranco Lessiani Peter Marschang Zsolt Pecsvarady Manlio Prior Manlio Prior Attila Puskas Andrzej Szuba |
| author_facet | Benilde Cosmi Benilde Cosmi Agata Stanek Matja Kozak Paul W. Wennberg Raghu Kolluri Marc Righini Pavel Poredos Michael Lichtenberg Mariella Catalano Sergio De Marchi Sergio De Marchi Katalin Farkas Paolo Gresele Peter Klein-Wegel Gianfranco Lessiani Peter Marschang Zsolt Pecsvarady Manlio Prior Manlio Prior Attila Puskas Andrzej Szuba |
| author_sort | Benilde Cosmi |
| collection | DOAJ |
| description | ImportanceThe post-thrombotic syndrome (PTS) is the most common long-term complication of deep vein thrombosis (DVT), occurring in up to 40–50% of cases. There are limited evidence-based approaches for PTS clinical management.ObjectiveTo provide an expert consensus for PTS diagnosis, prevention, and treatment.Evidence-ReviewMEDLINE, Cochrane Database review, and GOOGLE SCHOLAR were searched with the terms “post-thrombotic syndrome” and “post-phlebitic syndrome” used in titles and abstracts up to September 2020.Filters WereEnglish, Controlled Clinical Trial / Systematic Review / Meta-Analysis / Guideline. The relevant literature regarding PTS diagnosis, prevention and treatment was reviewed and summarized by the evidence synthesis team. On the basis of this review, a panel of 15 practicing angiology/vascular medicine specialists assessed the appropriateness of several items regarding PTS management on a Likert-9 point scale, according to the RAND/UCLA method, with a two-round modified Delphi method.FindingsThe panelists rated the following as appropriate for diagnosis: 1-the Villalta scale; 2- pre-existing venous insufficiency evaluation; 3-assessment 3–6 months after diagnosis of iliofemoral or femoro-popliteal DVT, and afterwards periodically, according to a personalized schedule depending on the presence or absence of clinically relevant PTS. The items rated as appropriate for symptom relief and prevention were: 1- graduated compression stockings (GCS) or elastic bandages for symptomatic relief in acute DVT, either iliofemoral, popliteal or calf; 2-thigh-length GCS (30–40 mmHg at the ankle) after ilio-femoral DVT; 3- knee-length GCS (30–40 mmHg at the ankle) after popliteal DVT; 4-GCS for different length of times according to the severity of periodically assessed PTS; 5-catheter-directed thrombolysis, with or without mechanical thrombectomy, in patients with iliofemoral obstruction, severe symptoms, and low risk of bleeding. The items rated as appropriate for treatment were: 1- thigh-length GCS (30–40 mmHg at the ankle) after iliofemoral DVT; 2-compression therapy for ulcer treatment; 3- exercise training. The role of endovascular treatment (angioplasty and/or stenting) was rated as uncertain, but it could be considered for severe PTS only in case of stenosis or occlusion above the inguinal ligament, followed by oral anticoagulation.Conclusions and RelevanceThis position paper can help practicing clinicians in PTS management. |
| first_indexed | 2024-12-13T13:12:31Z |
| format | Article |
| id | doaj.art-2ed094d1e03f48aab086eb05b02d4916 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-13T13:12:31Z |
| publishDate | 2022-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-2ed094d1e03f48aab086eb05b02d49162022-12-21T23:44:39ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-02-01910.3389/fcvm.2022.762443762443The Post-thrombotic Syndrome-Prevention and Treatment: VAS-European Independent Foundation in Angiology/Vascular Medicine Position PaperBenilde Cosmi0Benilde Cosmi1Agata Stanek2Matja Kozak3Paul W. Wennberg4Raghu Kolluri5Marc Righini6Pavel Poredos7Michael Lichtenberg8Mariella Catalano9Sergio De Marchi10Sergio De Marchi11Katalin Farkas12Paolo Gresele13Peter Klein-Wegel14Gianfranco Lessiani15Peter Marschang16Zsolt Pecsvarady17Manlio Prior18Manlio Prior19Attila Puskas20Andrzej Szuba21Division of Angiology and Blood Coagulation, Department of Specialty, Diagnostic and Experimental Medicine, S. Orsola Malpighi University Hospital Research Institute IRCSS, University of Bologna, Bologna, ItalyInter-University Research Center on Vascular Diseases & Angiology Unit, University of Milan, L Sacco Hospital, VAS-European Independent Foundation in Angiology/Vascular Medicine, Milan, ItalyDepartment of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Bytom, PolandDepartment for Vascular Diseases, Medical Faculty of Ljubljana, University Medical Center Ljubljana, Ljubljana, SloveniaDepartment of Cardiovascular Medicine, Gonda Vascular Center, Mayo Clinic, Rochester, MN, United StatesCardiovascular Medicine, OhioHealth/Riverside Methodist Hospital, Columbus, OH, United StatesDivision of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, SwitzerlandDepartment for Vascular Disease, University Medical Center Ljubljana, Ljubljana, SloveniaMichael Lichtenberg, Klinikum Hochsauerland, Arnsberg, GermanyInter-University Research Center on Vascular Diseases & Angiology Unit, University of Milan, L Sacco Hospital, VAS-European Independent Foundation in Angiology/Vascular Medicine, Milan, ItalyInter-University Research Center on Vascular Diseases & Angiology Unit, University of Milan, L Sacco Hospital, VAS-European Independent Foundation in Angiology/Vascular Medicine, Milan, Italy0Unit of Angiology, Department of Medicine - University of Verona, Cardiovascular and Thoracic Department, Verona University Hospital, Verona, Italy1Department of Angiology, Szent Imre University Teaching Hospital, Budapest, Hungary2Department of Medicine and Surgery, University of Perugia, Perugia, Italy3Angiologic Clinic, Interdisciplinary Center of Vascular Medicine, Klinikum Ernst von Bergmann, Potsdam, Germany4Angiology Unit, Department of Internal Medicine, Città Sant'Angelo Hospital, Pescara, Italy5Department of Internal Medicine, Central Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy62nd Department of Internal Medicine - Vascular Center, Flor Ferenc Teaching Hospital, Kistarcsa, HungaryInter-University Research Center on Vascular Diseases & Angiology Unit, University of Milan, L Sacco Hospital, VAS-European Independent Foundation in Angiology/Vascular Medicine, Milan, Italy0Unit of Angiology, Department of Medicine - University of Verona, Cardiovascular and Thoracic Department, Verona University Hospital, Verona, Italy7Angio Center-Vascular Medicine Private Clinic, Tirgu Mures, Romania8Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, PolandImportanceThe post-thrombotic syndrome (PTS) is the most common long-term complication of deep vein thrombosis (DVT), occurring in up to 40–50% of cases. There are limited evidence-based approaches for PTS clinical management.ObjectiveTo provide an expert consensus for PTS diagnosis, prevention, and treatment.Evidence-ReviewMEDLINE, Cochrane Database review, and GOOGLE SCHOLAR were searched with the terms “post-thrombotic syndrome” and “post-phlebitic syndrome” used in titles and abstracts up to September 2020.Filters WereEnglish, Controlled Clinical Trial / Systematic Review / Meta-Analysis / Guideline. The relevant literature regarding PTS diagnosis, prevention and treatment was reviewed and summarized by the evidence synthesis team. On the basis of this review, a panel of 15 practicing angiology/vascular medicine specialists assessed the appropriateness of several items regarding PTS management on a Likert-9 point scale, according to the RAND/UCLA method, with a two-round modified Delphi method.FindingsThe panelists rated the following as appropriate for diagnosis: 1-the Villalta scale; 2- pre-existing venous insufficiency evaluation; 3-assessment 3–6 months after diagnosis of iliofemoral or femoro-popliteal DVT, and afterwards periodically, according to a personalized schedule depending on the presence or absence of clinically relevant PTS. The items rated as appropriate for symptom relief and prevention were: 1- graduated compression stockings (GCS) or elastic bandages for symptomatic relief in acute DVT, either iliofemoral, popliteal or calf; 2-thigh-length GCS (30–40 mmHg at the ankle) after ilio-femoral DVT; 3- knee-length GCS (30–40 mmHg at the ankle) after popliteal DVT; 4-GCS for different length of times according to the severity of periodically assessed PTS; 5-catheter-directed thrombolysis, with or without mechanical thrombectomy, in patients with iliofemoral obstruction, severe symptoms, and low risk of bleeding. The items rated as appropriate for treatment were: 1- thigh-length GCS (30–40 mmHg at the ankle) after iliofemoral DVT; 2-compression therapy for ulcer treatment; 3- exercise training. The role of endovascular treatment (angioplasty and/or stenting) was rated as uncertain, but it could be considered for severe PTS only in case of stenosis or occlusion above the inguinal ligament, followed by oral anticoagulation.Conclusions and RelevanceThis position paper can help practicing clinicians in PTS management.https://www.frontiersin.org/articles/10.3389/fcvm.2022.762443/fullpost-thrombotic syndromepost-phlebitic syndromedeep vein thrombosispreventiondiagnosistreatment |
| spellingShingle | Benilde Cosmi Benilde Cosmi Agata Stanek Matja Kozak Paul W. Wennberg Raghu Kolluri Marc Righini Pavel Poredos Michael Lichtenberg Mariella Catalano Sergio De Marchi Sergio De Marchi Katalin Farkas Paolo Gresele Peter Klein-Wegel Gianfranco Lessiani Peter Marschang Zsolt Pecsvarady Manlio Prior Manlio Prior Attila Puskas Andrzej Szuba The Post-thrombotic Syndrome-Prevention and Treatment: VAS-European Independent Foundation in Angiology/Vascular Medicine Position Paper Frontiers in Cardiovascular Medicine post-thrombotic syndrome post-phlebitic syndrome deep vein thrombosis prevention diagnosis treatment |
| title | The Post-thrombotic Syndrome-Prevention and Treatment: VAS-European Independent Foundation in Angiology/Vascular Medicine Position Paper |
| title_full | The Post-thrombotic Syndrome-Prevention and Treatment: VAS-European Independent Foundation in Angiology/Vascular Medicine Position Paper |
| title_fullStr | The Post-thrombotic Syndrome-Prevention and Treatment: VAS-European Independent Foundation in Angiology/Vascular Medicine Position Paper |
| title_full_unstemmed | The Post-thrombotic Syndrome-Prevention and Treatment: VAS-European Independent Foundation in Angiology/Vascular Medicine Position Paper |
| title_short | The Post-thrombotic Syndrome-Prevention and Treatment: VAS-European Independent Foundation in Angiology/Vascular Medicine Position Paper |
| title_sort | post thrombotic syndrome prevention and treatment vas european independent foundation in angiology vascular medicine position paper |
| topic | post-thrombotic syndrome post-phlebitic syndrome deep vein thrombosis prevention diagnosis treatment |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.762443/full |
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