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Surgical and non-surgical approaches in the management of lower limb post-thrombotic syndrome

Title: Surgical and non-surgical approaches in the management of lower limb post-thrombotic syndrome
Authors: Machin, M
Salim, S
Tan, M
Onida, S
Davies, AH
Shalhoub, J
Item Type: Journal Article
Abstract: Introduction: Post-thrombotic syndrome (PTS) is a common lifelong condition affecting up to 50% of those suffering from deep vein thrombosis (DVT). PTS compromises function and quality of life with subsequent venous ulceration in up to 29% of those affected. Areas covered: A literature review of surgical and non-surgical approaches in the prevention and treatment of PTS was undertaken. Notable areas include the use of percutaneous endovenous interventions and the use of graduated compression stockings (GCS) after acute proximal DVT. Expert opinion: In patients with acute iliofemoral DVT, we think it is important to have a frank conversation with the patient about catheter-directed thrombolysis, aiming to reduce the severity of PTS experienced. We advocate ultrasound-accelerated thrombolysis with adjunctive procedures, such as deep venous stenting for proximal iliofemoral DVT. For patients with isolated femoral DVT, we believe that anticoagulation and GCS should be recommended. In patients with established PTS, we recommend GCS for symptomatic relief. We recommend that patients engage in regular exercise where possible with the prospect of gaining symptomatic relief. For those with severe PTS that has a significant effect on quality of life, we discuss the patient’s case at a multi-disciplinary team meeting to plan for endovenous intervention.
Issue Date: 1-Mar-2021
Date of Acceptance: 12-Jan-2021
URI: http://hdl.handle.net/10044/1/86123
DOI: 10.1080/14779072.2021.1876563
ISSN: 1477-9072
Publisher: Informa UK Limited
Start Page: 191
End Page: 200
Journal / Book Title: Expert Review of Cardiovascular Therapy
Volume: 19
Issue: 3
Copyright Statement: © 2021 Taylor & Francis. This is an Accepted Manuscript of an article published by Taylor & Francis in Expert Review of Cardiovascular Therapy on 18 January 2021, available online: https://doi.org/10.1080/14779072.2021.1876563
Keywords: Science & Technology
Life Sciences & Biomedicine
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Catheter-directed thrombolysis
deep venous thrombosis
deep venous stent
endovenous ultrasound
endovenous thrombectomy
lower limb edema
iliac vein stent
post-thrombotic syndrome
ulceration
Catheter-directed thrombolysis
deep venous stent
deep venous thrombosis
endovenous thrombectomy
endovenous ultrasound
iliac vein stent
lower limb edema
post-thrombotic syndrome
ulceration
1102 Cardiorespiratory Medicine and Haematology
1117 Public Health and Health Services
Cardiovascular System & Hematology
Publication Status: Published
Article Number: 14779072.2021.1876563
Online Publication Date: 2021-01-18
Appears in Collections:Department of Surgery and Cancer
Faculty of Medicine