{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T03:57:34Z","timestamp":1790135854043,"version":"4.0.1"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,2,24]],"date-time":"2022-02-24T00:00:00Z","timestamp":1645660800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Importance<\/jats:title><jats:p>The post-thrombotic syndrome (PTS) is the most common long-term complication of deep vein thrombosis (DVT), occurring in up to 40\u201350% of cases. There are limited evidence-based approaches for PTS clinical management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To provide an expert consensus for PTS diagnosis, prevention, and treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Evidence-Review<\/jats:title><jats:p>MEDLINE, Cochrane Database review, and GOOGLE SCHOLAR were searched with the terms \u201cpost-thrombotic syndrome\u201d and \u201cpost-phlebitic syndrome\u201d used in titles and abstracts up to September 2020.<\/jats:p><\/jats:sec><jats:sec><jats:title>Filters Were<\/jats:title><jats:p>English, Controlled Clinical Trial \/ Systematic Review \/ Meta-Analysis \/ Guideline. The relevant literature regarding PTS diagnosis, prevention and treatment was reviewed and summarized by the evidence synthesis team. On the basis of this review, a panel of 15 practicing angiology\/vascular medicine specialists assessed the appropriateness of several items regarding PTS management on a Likert-9 point scale, according to the RAND\/UCLA method, with a two-round modified Delphi method.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>The panelists rated the following as appropriate for diagnosis: 1-the Villalta scale; 2- pre-existing venous insufficiency evaluation; 3-assessment 3\u20136 months after diagnosis of iliofemoral or femoro-popliteal DVT, and afterwards periodically, according to a personalized schedule depending on the presence or absence of clinically relevant PTS. The items rated as appropriate for symptom relief and prevention were: 1- graduated compression stockings (GCS) or elastic bandages for symptomatic relief in acute DVT, either iliofemoral, popliteal or calf; 2-thigh-length GCS (30\u201340 mmHg at the ankle) after ilio-femoral DVT; 3- knee-length GCS (30\u201340 mmHg at the ankle) after popliteal DVT; 4-GCS for different length of times according to the severity of periodically assessed PTS; 5-catheter-directed thrombolysis, with or without mechanical thrombectomy, in patients with iliofemoral obstruction, severe symptoms, and low risk of bleeding. The items rated as appropriate for treatment were: 1- thigh-length GCS (30\u201340 mmHg at the ankle) after iliofemoral DVT; 2-compression therapy for ulcer treatment; 3- exercise training. The role of endovascular treatment (angioplasty and\/or stenting) was rated as uncertain, but it could be considered for severe PTS only in case of stenosis or occlusion above the inguinal ligament, followed by oral anticoagulation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This position paper can help practicing clinicians in PTS management.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.762443","type":"journal-article","created":{"date-parts":[[2022,2,24]],"date-time":"2022-02-24T05:30:55Z","timestamp":1645680655000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":19,"title":["The Post-thrombotic Syndrome-Prevention and Treatment: VAS-European Independent Foundation in Angiology\/Vascular Medicine Position 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