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    Villalta Score for Post-thrombotic Syndrome (PTS)

    Stratifies severity of post-thrombotic syndrome in lower extremity DVT.
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    INSTRUCTIONS

    Use in patients with lower extremity DVT. Note: all symptoms and signs refer to the affected leg.

    When to Use
    Pearls/Pitfalls
    Why Use

    • Use in patients with lower extremity signs and symptoms related to DVT (e.g. swelling, discoloration, ulceration) and clinical suspicion for post-thrombotic syndrome (PTS).

    • Should defer PTS diagnosis until after the acute DVT phase has passed (3–6 months).

    Venous ulceration indicates severe PTS and automatically confers a score of ≥15.

    PTS can be seen in up to half of patients with lower extremity DVT within 2 years. This score both diagnoses and grades severity of PTS.

    Symptoms
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Clinical signs
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    0
    Mild
    +1
    Moderate
    +2
    Severe
    +3
    Absent
    Present

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Management

    • May consider conservative treatment, e.g. elastic compression stockings (ECS), for mild to moderate PTS.

    • In patients with moderate to severe PTS uncontrolled with ECS alone, may consider intermittent compression devices or pneumatic compression sleeve units.

    • For lifestyle limiting refractory and/or severe PTS, may consider endovascular treatment.

    Critical Actions

    Clinical severity, multidisciplinary evaluation, and patient preference should guide management.

    Content Contributors
    • Andrew Kesselman, MD
    About the Creator
    Dr. Sabina Villalta
    Are you Dr. Sabina Villalta?
    Content Contributors
    • Andrew Kesselman, MD