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Post-Thrombotic Syndrome (PTS) Overview

A common complication of post-thrombotic syndrome can occur in patients after experiencing a Deep Vein Thrombosis (DVT).  The small valves found inside the veins in the arms and legs allow/help the blood to flow properly in the body.  If a DVT occurs, the clot/blockage can damage the valves, preventing proper blood flow from happening.

Post-Thrombotic Syndrome Causes

The leading cause of Post-Thrombotic Syndrome (PTS) is the valves or walls of the veins being damaged as a result of DVT. It is a chronic condition that can lead to long-term complications. This is managed by vascular specialists and requires long-term follow-up.

Post-Thrombotic Syndrome Risk Factors & Symptoms

One-third of DVT patients can develop Post-Thrombotic Syndrome (PTS) in their medical future. If you have had any of the risk factors listed below, you are more likely to develop PTS.

Risk Factors

  • Age 65 years or older
  • A blood clot in the deep veins
  • Multiple blood clots in the same leg
  • Overweight
  • Difficulty maintaining stable blood thinner levels

The valves in your veins are responsible for making sure the blood is flowing toward the heart. However, reflux can occur when the blood flows in the opposite direction because of the damaged valves. This abnormal flow causes discomfort, swelling, and skin damage in patients.

illustration of artery with plaque from post thrombotic syndrome
As the condition of PTS worsens, severe damage to skin can occur along with itchiness and discoloration. Neglecting or not seeking treatment/advice may result in a sore on the leg also known as a venous ulcer. A physical examination, followed by an ultrasound is the first step in evaluating a patient’s condition. Every patient may experience different symptoms, with some not having any identifiable symptoms at all.

Common PTS Symptoms

  • Pain
  • Swelling that worsens when walking or standing for long periods of time
  • Aching or heaviness in the leg or foot
  • Cramping or Tingling in the leg or foot
  • Itching in the leg or foot
  • Unusual blue or brown pigmentation in the leg or foot
  • An ulcer or sore that develops on the leg or foot
  • Development of new varicose veins
  • Dry, red & flaky skin

If you are experiencing these signs/symptoms and have had a DVT, listen to your body and be evaluated.

woman's leg with varicose veins from post thrombotic syndrome

You Have a Choice When It Comes to Vascular Care.
Get an Appointment at VIC In 3 to 5 Days – Without a Referral!

You Have a Choice When It Comes to Vascular Care.
Get an Appointment at VIC In 3 to 5 Days – Without a Referral!

Post-Thrombotic Syndrome Diagnosis

In patients who show the signs of chronic venous insufficiency, swelling of the leg and skin changes, or who have had known DVT, a vascular specialist exam is required to stage the disease process. Often an ultrasound would be performed to detect chronic DVT or valvular dysfunction. Preventive measures for vein and skin health would be recommended.

Post-Thrombotic Syndrome Treatment

Several treatment options, depending on the severity of the PTS can be prescribed for the patient.  In some cases, a surgical intervention may be required. This is when finding a certified vascular surgeon/specialist is crucial for the optimal outcome.
  • Exercise/Elevation of the affected legs
  • Compression stockings
  • Medication
  • Intervention

Post-Thrombotic Syndrome Prevention

Reducing the risk or further damage that can be caused by PPTS can include adopting the following:  walking and moving as you can, do not sit for long periods of time, using compression devices/compression stockings or hose, and appropriate medications such as blood thinners that are prescribed by your provider following a physical exam.
senior adults walking together outside to prevent post thrombotic syndrome

Post-Thrombotic Syndrome Progression

While the condition cannot be reversed, it can be managed with lifestyle changes. The progression of the disease will lead to discomfort, itchiness, and redness of the skin on the legs. Pressure in the legs worsens over time, and the vein walls and valves are affected, limiting the blood flow and making it a true mobility problem for some. Venous ulcers or sores can form at the ankle area and can be very difficult to treat.


PTS is a challenging condition to live with because it never will truly go away but is manageable with lifestyle choices and modification, compression hose, and medication.
Leg ulcers and wounds may be a result of PTS, which require being monitored by a wound care specialist.  If wounds are not managed properly, damage can continue to worsen, potentially leading to surgical intervention.

Listen to your body always. If you notice increasing pain or an ulcer forming on the leg, the presence of infection on an ulcer that is already present, increased swelling, or heaviness in the legs, this is when you need to reach out to your provider to be checked and evaluated to prevent further damage that may occur.


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