Journal of General Internal Medicine

, Volume 15, Issue 6, pp 425–429

Long-term outcomes after deep vein thrombosis: Postphlebitic syndrome and quality of life

  • Susan R. Kahn
  • Susan Solymoss
  • Donna L. Lamping
  • Lucien Abenhaim


In this review, we critically assess the literature on the incidence of postphlebitic syndrome, risk factors for its occurrence, available therapeutic options, and its effects on quality of life. As well, we describe available tools to measure postphlebitic syndrome. Recent prospective studies indicate that postphlebitic syndrome, a chronic, potentially disabling condition characterized by leg swelling, pain, venous ectasia, and skin induration, is established by 1 year after deep vein thrombosis (DVT) in 17% to 50% of patients. The only prospectively identified risk factor for its occurrence is recurrent ipsilateral DVT. In the sole randomized study available, daily use of elastic compression stockings after proximal DVT reduced the incidence of postphlebitic syndrome by 50%. Treatment options for established postphlebitic syndrome are limited, but include compression stockings and intermittent compressive therapy with an extremity pump for severe cases. To date, quality of life after DVT has received little attention in the literature. The recent development of the VEINES-QOL questionnaire, a validated venous-disease-specific measure of quality of life, should encourage researchers to include quality of life as a routine outcome measure after DVT. There is no criterion standard for the diagnosis of postphlebitic syndrome, but a validated clinical scoring system does exist. More research on postphlebitic syndrome is needed to enable us to provide DVT patients with comprehensive, evidence-based information regarding their long-term prognosis, to help quantify the prevalence and health care burden of postphlebitic syndrome, and by identifying predictors of poor outcome, to develop new preventive strategies in patients at risk of developing this condition.

Key words

postphlebitic syndrome deep vein thrombosis quality of life long-term outcome 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Anderson FA, Wheeler HB, Goldberg RJ et al. A population-based perspective on the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med. 1991;151:933–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Strandness DE, Langlois Y, Cramer M, et al. Long-term sequelae of acute venous thrombosis. JAMA. 1983;250(10):1289–92.PubMedCrossRefGoogle Scholar
  3. 3.
    Lindner DJ, Edwards JM, Phinney ES, et al. Long-term hemodynamic and clinical sequelae of lower extremity deep vein thrombosis. J Vasc Surg. 1986;4:436–42.PubMedCrossRefGoogle Scholar
  4. 4.
    Villalta S, Bagatella P, Piccioli A, et al. Assessment of validity and reproducibility of a clinical scale for the post-thrombotic syndrome. Hemostasis 1994;24(suppl 1):158a. Abstract.Google Scholar
  5. 5.
    Prandoni P, Lensing AWA, Cogo A. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med. 1996;125:1–7.PubMedGoogle Scholar
  6. 6.
    Brandjes DPM, Buller HR, Heijboer H. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet. 1997;349:759–62.PubMedCrossRefGoogle Scholar
  7. 7.
    Villalta S, Prandoni P, Cogo A, et al. The utility of non-invasive tests for detection of previous proximal-vein thrombosis. Thrombos Haemost. 1995;73:592–6.Google Scholar
  8. 8.
    Beyth RJ, Cohen AM, Landefeld CS. Long-term outcomes of deep-vein thrombosis. Arch Intern Med. 1995;155:1031–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Browse NL, Clemenson G, Lea Thomas M. Is the postphlebitic leg always postphlebitic? Relation between phlebographic appearances of deep-vein thrombosis and late sequelae. BMJ. 1980;281:1167–70.PubMedGoogle Scholar
  10. 10.
    Philbrick JT, Becker DM. Calf venous thrombosis: a wolf in sheep’s clothing? Arch Intern Med. 1988;148:2131–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Mewissen MW, Seabrook GR, Meissner MH, Cynamon J, Labropoulos N, Haughton SH. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology. 1999;211:39–49.PubMedGoogle Scholar
  12. 12.
    Kakkar VV, Lawrence D. Hemodynamic and clinical assessment after therapy for acute venous thrombosis: a prospective study. Am J Surg. 1985;54–63.Google Scholar
  13. 13.
    Trubestein G. Can thrombolytics prevent post-phlebitic syndrome and thromboembolic disease? Hemostasis. 1986;3(suppl 6):38–50.Google Scholar
  14. 14.
    Munkvad S, Jorgensen M. Resistance to activated protein C: a common anticoagulant deficiency in patients with venous leg ulceration. Br J Dermatol. 1996;134:296–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Wille-Jorgensen P, Jorgensen T, Andersen M, et al. Postphlebitic syndrome and general surgery: an epidemiological investigation. Angiology. 1991;397–403.Google Scholar
  16. 16.
    Hull R, Delmore F, Carter C, et al. Adjusted subcutaneous heparin versus warfarin sodium in the long-term treatment of venous thrombosis. N Engl J Med. 1982;306:189–94.PubMedCrossRefGoogle Scholar
  17. 17.
    Kearon C, Gent M, Hirsch J, et al. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med. 1999;340:901–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Biguzzi E, Mozzi E, Alatri A, Taioli E, Moia M, Mannicci PM. The post-thrombotic syndrome in young women: retrospective evaluation of prognostic factors. Thromb Haemost. 1998;80:575–7.PubMedGoogle Scholar
  19. 19.
    Dalen JE, Hirsh J, eds. Fifth ACCP Consensus Conference on Antithrombotic Therapy. Chest. 1998;114(suppl).Google Scholar
  20. 20.
    Ridker PM, for the PREVENT Investigators. Long-term, low-dose warfarin among venous thrombosis patients with and without factor V Leiden mutation: rationale and design for the Prevention of Recurrent Venous Thromboembolism (PREVENT) Trial. Vasc Med. 1998;3:67–73.PubMedGoogle Scholar
  21. 21.
    Gandhi DB, Palmar JR, Lewis B, Schraibman IG. Clinical comparison of elastic supports for venous diseases of the lower limb. Postgrad Med J. 1984;60:249–52.Google Scholar
  22. 22.
    Alguire PC, Mathes BM. Chronic venous insufficiency and venous ulceration. J Gen Intern Med. 1997;12:374–83.PubMedCrossRefGoogle Scholar
  23. 23.
    Ginsberg JS, Brill-Edwards P, Kowalchuk G, Hirsh J. Intermittent compression units for the postphlebitic syndrome: a pilot study. Arch Intern Med. 1989;149:1651–2.PubMedCrossRefGoogle Scholar
  24. 24.
    Ginsberg JS, Magier D, MacKinnon B, Gent M, Hirsh J. Intermittent compression units for severe post-phlebitic syndrome: a randomized crossover study. CMAJ. 1999;160:1303–6.PubMedGoogle Scholar
  25. 25.
    Lamping DL. Measuring health-related quality of life in venous disease: practical and scientific considerations. Angiology. 1997;48:51–57.PubMedCrossRefGoogle Scholar
  26. 26.
    O’Donnell TF Jr, Browse NL, Burnand KG. The socioeconomic effects of an ileofemoral venous thrombosis. J Surg Res. 1977;22:483–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Garratt AM, Macdonald LM, Ruta DA, et al. Towards measurement of outcome for patients with varicose veins. Qual Health Care. 1993;2:5–10.PubMedGoogle Scholar
  28. 28.
    Franks PJ, Moffatt CJ, Connolly M, et al. Community leg ulcer clinics: effect on quality of life. Phlebology. 1994;9:83–6.Google Scholar
  29. 29.
    Hyland ME, Thomson B. Quality of life of leg ulcer patients: questionnaire and preliminary findings. J Wound Care. 1994;3:294–8.Google Scholar
  30. 30.
    Garratt AM, Ruta DA, Abdalla MI, et al. The SF-36 health survey questionnaire: an outcome measure suitable for routine use within the NHS? BMJ. 1993;306:1440–4.PubMedCrossRefGoogle Scholar
  31. 31.
    Price P, Harding K. Quality of life. Lancet. 1995;346:445. Letter.PubMedCrossRefGoogle Scholar
  32. 32.
    Lindholm C, Bjellerup M, Christensen OB, et al. Quality of life in chronic leg ulcer patients. Acta Dermato-Venereol. 1993;73:440–3.Google Scholar
  33. 33.
    Franks PJ, Wright DDI, Fletcher AE, et al. A questionnaire to assess risk factors, quality of life, and use of health resources in patients with venous disease. Eur J Surg. 1992;158:149–55.PubMedGoogle Scholar
  34. 34.
    Launois R, Reboul-Marty J, Henry B. Construction et validation d’un indicateur spécifique de qualité de vie: le cas de l’insuffisance veineuse chronique des membres inférieurs. J Econ Med. 1994;12:109–26.Google Scholar
  35. 35.
    Launois R, Reboul-Marty J, Henry B. Construction and validation of a quality of life questionnaire in chronic lower limb venous insufficiency (CIVIQ). Qual Life Res. 1996;5:539–54.PubMedCrossRefGoogle Scholar
  36. 36.
    Lamping DL, Abenhaim LA, Kurz X, Schroter S, Kahn SR, and the VEINES Group. Measuring quality of life and symptoms in chronic venous disorders of the leg: development and psychometric evaluation of the VEINES-QOL/VEINES-SYM questionnaire. Qual Life Res. 1998;7(7):621–2. Abstract.Google Scholar
  37. 37.
    Ware JE Jr, Kosinki MA, Keller SD. SF-36 Physical and Mental Component Summary Measures: A User’s Manual. Boston, Mass: The Health Institute, New England Medical Center; 1994.Google Scholar

Copyright information

© Society of General Internal Medicine 2000

Authors and Affiliations

  • Susan R. Kahn
    • 1
  • Susan Solymoss
    • 2
  • Donna L. Lamping
    • 3
  • Lucien Abenhaim
    • 1
  1. 1.Center for Clinical Epidemiology and Community StudiesSir Mortimer B. Davis Jewish General HospitalMontrealCanada
  2. 2.Division of HematologyMontreal General HospitalMontrealCanada
  3. 3.Health Services Research UnitLondon School of Hygiene and Tropical MedicineLondonU.K.

Personalised recommendations