Home Topics Dvt ComplicationsSkin Disorders

Skin Disorders and Postthrombotic Syndrome

Postthrombotic syndrome (PTS) occurs in 25 percent to 41 percent of DVT cases. PTS, which is also known as postphlebitic syndrome and chronic venous insufficiency (CVI), can lead to hyperpigmentation of the legs. It can also cause chronic swelling (edema). Some patients with PTS will also develop skin ulcers on the legs and feet.

Risk Factors and Prevention PTS

PTS occurs much more commonly in older patients and in patients with multiple episodes of DVT, or recurrent DVT. According to a recent study, the use of compression stockings in patients who have had an initial episode of DVT reduced the chance of developing PTS from nearly 50 percent to only 25 percent.

Elastic compression stockings may help prevent PTS by providing pressure around the lower leg, reducing the chance of edema, hyperpigmentation and ulcers associated with PTS.

Symptoms of Postthrombotic Syndrome

The symptoms of PTS include:

edema
hyperpigmentation (darkening of the skin)
leg discomfort
lesions or ulcers on the legs or feet
varicose veins.

In PTS, edema occurs when blood pools in the legs or feet. This pooling can lead to hyperpigmentation, causing patches of skin to become darker than the surrounding skin. Ulcers and lesions can also occur in the legs or feet, usually within areas of hyperpigmentation. Ulcers and lesions are areas of open, damaged skin that do not heal.

Leg discomfort and varicose veins are other possible symptoms of PTS in patients with DVT. Varicose veins result when the pressure of the blood inside the veins makes the veins enlarged and twisted, pushing the veins up to the surface of the skin.

Treatment of Postthrombotic Syndrome

PTS and its symptoms of edema and hyperpigmentation can be treated by a variety of medical methods. PTS is rarely treated with surgery, which usually only removes clots and does little to prevent new ones from forming.

Treatment options include:

elevating the legs above the level of the heart
using anticoagulants (drugs that thin the blood and prevent clots from forming)
using compression stockings (stockings that help improve circulation in the legs)
using thrombolytics (drugs that break up existing blood clots).

To treat skin ulcers, your doctor may prescribe antibiotics if the ulcer is infected. He will also likely suggest topical wound care and a variety of dressings to help the ulcer heal.

If the ulcer takes longer than six months to heal, it may require surgery. Surgical options include grafting new skin to the ulcer or operating on the veins that surround it.

Varicose veins can be painful and are treated with a variety of techniques, including:

Catheter-Assisted Procedures: Catheter-assisted procedures are usually used on larger veins and involve heating the tip of a catheter to destroy the vein's structure, sealing it shut.
Laser Surgery: In laser treatment, an intense beam of light is used to close off small veins and reduce varicose veins.
Sclerotherapy: Sclerotherapy involves injecting small and medium-sized veins with a mixture that scars the veins and causes them to close off.

It should be noted that the surgical treatments for skin ulcers and varicose veins deal only with the symptoms of PTS. They are not curative and will not prevent new ulcers or varicose veins from forming.

Resources

Cleveland Clinic. (n.d.). Lower Extremity (Leg and Foot) Ulcers. Retrieved July 19, 2007, from the Cleveland Clinic Web site: http://www.clevelandclinic.org/heartcenter/pub/guide/disease/
vascular/legfootulcer.htm.

de Azevedo Prazeres, G. (n.d.). Deep Vein Thrombosis – Part II. Retrieved July 19, 2007, from the Med Students Web site: http://www.medstudents.com.br/medint/medint5.htm.

Grossman, A.B., Sowa, M. (2004). A Closer Look at Deep Vein Thrombosis. Podiatry Today, 17(12), 30-34.

Johnson, B.F., Manzo, R.A., Bergelin, R.O., Strandness, D.E. (1995). Relationship between changes in the deep venous system and the development of the postthrombotic syndrome after an acute episode of lower limb deep vein thrombosis: a one- to six-year follow up. Journal of Vascular Surgery, 21(2), 307-312.

Mayo Clinic. (January 16, 2007). Varicose Veins: Treatment. Retrieved July 19, 2007, from the Mayo Clinic Web site: http://www.mayoclinic.com/health/varicose-veins/DS00256/DSECTION=8.

Prandoni, P, Lensing A.W., Prins, M.H., et al. (2004). Below-knee elastic compression stockings to prevent the post-thrombotic syndrome. A randomized, controlled trial. Annals of Internal Medicine, 141, 249-256.

Tessier, D.J., Podnos, Y.D. (October 5, 2006). Chronic Venous Insufficiency. Retrieved July 19, 2007, from the eMedicine Web site: http://www.emedicine.com/med/topic2760.htm.

Other Topics in this Section

Add a Comment

Print this Article

Email to a Friend