Thrombosis and Hemostasis Unit, Hematology Institute, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
Center for Clinical Epidemiology, Jewish General Hospital, McGill University, Montreal, Canada.
J Thromb Haemost. 2017 Feb;15(2):230-241. doi: 10.1111/jth.13569. Epub 2017 Jan 23.
Postthrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT) that develops in 20-50% of patients. PTS manifests as a spectrum of symptoms and signs of chronic venous insufficiency that can impose significant morbidity and have a negative impact on quality of life. Chronic venous hypertension caused by a combination of residual venous obstruction and valvular reflux is believed to play a major role in the pathophysiology of PTS. The Villalta scale is the most widely applied clinical scale used to diagnose and define PTS. Proximal DVT and recurrent ipsilateral DVT are the two principal established risk factors for PTS, and efforts in recent years have been focused on identifying a combination of clinical and biomarker predictors that will define high-risk patients and possibly new therapeutic targets. The best way to prevent PTS is to prevent the occurrence of DVT, and to provide optimal anticoagulation for the acute phase of DVT once it occurs. Recent years have brought progress in our understanding of the role of endovascular techniques in the prevention and treatment of PTS and the subgroups of patients that may benefit from these modalities. Pharmacomechanical catheter-directed thrombolysis is the most promising interventional modality for prevention of PTS. This review summarizes the current state of evidence on PTS of the lower limbs, and highlights areas where uncertainty still exists that require further research.
深静脉血栓后综合征（PTS）是深静脉血栓（DVT）的一种慢性并发症，在 20-50%的患者中发生。PTS 表现为慢性静脉功能不全的一系列症状和体征，可导致显著的发病率，并对生活质量产生负面影响。残余静脉阻塞和瓣膜反流引起的慢性静脉高压被认为在 PTS 的病理生理学中起主要作用。Villalta 量表是最广泛应用的用于诊断和定义 PTS 的临床量表。近端 DVT 和同侧复发性 DVT 是 PTS 的两个主要既定危险因素，近年来的研究重点是确定一系列临床和生物标志物预测因素，以定义高危患者，并可能确定新的治疗靶点。预防 PTS 的最佳方法是预防 DVT 的发生，并在 DVT 发生后为其急性期提供最佳抗凝治疗。近年来，我们对腔内技术在 PTS 及可能受益于这些方法的患者亚组的预防和治疗中的作用的理解取得了进展。机械性溶栓导管溶栓是预防 PTS 最有前途的介入治疗方法。这篇综述总结了目前关于下肢 PTS 的证据状况，并强调了仍存在需要进一步研究的不确定性领域。
