Can PTS be prevented?
Although anticoagulant drugs may help to prevent Post-Thrombotic Syndrome (PTS) by reducing the risk of recurrent DVT and/or reducing inflammation, PTS develops frequently despite the use of these medications (1,2,3,4). Studies differ on whether clot removal with CDT or PCDT can prevent PTS; the largest, most rigorous ATTRACT Study found that it did not.
Can PTS be Treated?
PTS is difficult to treat effectively. Treatments that are often used include:
- Elastic Compression Stockings;
- Devices that improve circulation in the leg called intermittent pneumatic compression or portable venous return assist devices;
- Supervised exercise programs; and
- Use of “venoactive” medications to improve blood flow.
Published care guidelines do not strongly recommend these therapies as being reliably effective. Basically, because the risk of harm is low, it is worth trying these conservative treatments but the long-term benefit may be limited (14).
In some cases, a more aggressive approach may be considered to treat PTS. To manage moderate-to-severe PTS symptoms or venous ulcers, patients may consider catheter-directed endovascular therapy (“EVT”) procedures to treat the narrowing or blockage of the blood flow through the large leg veins (“iliac vein obstruction”) and/or back flow (“reflux”) of blood due to leaky vein valves. These procedures have shown promising early results, but their long-term benefits and risks have not yet been clearly established in large, well-designed studies. The C-TRACT Study we are conducting was designed to answer these important questions.
EVT procedures for treatment of moderate-to-severe PTS include:
Stent Placement: A stent is a metal mesh tube that expands and props open a blood vessel. Although there is currently no FDA-approved venous stent, available stents have been used to treat iliac vein obstruction after catheter directed therapy or surgical removal of a clot for acute DVT (5, 15-21). In preliminary studies, stent placement in PTS patients with chronically occluded iliac veins has been associated with reduced obstructive venous physiology, healing of ulcers, and relief of symptoms (22-37).
Endovenous Ablation: Ablation refers to the catheter-directed delivery of heat, medications (causing shrinkage), or adhesive materials into a superficial vein with the intent of causing irreversible occlusion – thus eliminating valvular reflux. This 30-60 minute outpatient procedure may help to reduce venous pressure in the leg with PTS, improving symptoms.
Learn more about opportunities to participate in research trying to determine whether endovascular procedures reduce PTS severity and improve quality of life.
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