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Patients with complications of deep vein thrombosis (DVT) experience a “life changing event” stemming from their DVT. Constant swelling, pain and discoloration of the involved lower extremity are common. These symptoms result from “venous hypertension secondary to reflux, obstruction, or insufficiency of muscle pumps” (Kearon 2003; Labropoulos 2004). Although the symptoms are well described, patients often have no plan for long term follow up after the acute DVT event. The venous system adjusts to impaired valvular function and obstructed outflow venous channels in the first year following the DVT. A life long commitment to compression hose therapy (Franks, Moffatt et al. 1995) with ambulation and extremity elevation at rest will minimize swelling and pain. Unfortunately, in the acute phase patients often cannot tolerate compression hose but they should be “coached” into compression hose as soon as possible. “60% of patients post DVT develop post thrombotic syndrome (Ashrani, Silverstein et al. 2009); fitted, graded compression hose reduce the rate in half” (Kahn ; Brandjes, Buller et al. 1997; Pirard, Bellens et al. 2008). Following a course of anticoagulation and advice for compression hose therapy, DVT patients usually are followed by their primary care provider. Recently there has been increasing interest in more closely following DVT patients. A duplex supervised by a vascular/vein specialist should be performed to assess the “pumping” capacity, available venous channels and valvular competence a few weeks to months after a DVT event (van Ramshorst, van Bemmelen et al. 1994; Caps, Manzo et al. 1995; Salcuni, Fiorentino et al. 1996; Nicolaides 2000). This is especially indicated if patients experience persistent pain and swelling, or if a change occurs in the status of the limb swelling and pain after a long stable period, or if there is continued increase in pigmentation in the pressurized area. Chronic complications, post thrombotic syndrome (PTS), can present clinically depending on the initial severity of the deep venous abnormality, but may also develop abnormalities in the years following a DVT (Bradbury 2010). The overwhelming goal of the treatment of complicated post DVT patients is to preserve skin integrity and to prevent or heal ulceration (Kearon 2004; Bradbury 2010). Pain, infection, and loss of function result in a significant cost to the patient and the community as a whole.

Late Complications of Deep Venous Thrombosis: Painful Swollen Extremities and Non Healing Ulcers