The Role of Duplex Ultrasound in Diagnosis, Prediction, Treatment and Monitoring of Post-Thrombotic Syndrome: A Comprehensive Review.

OBJECTIVES

The diagnosis of post-thrombotic syndrome (PTS) is based on the presence of typical symptoms and signs in a patient with prior deep vein thrombosis (DVT). This condition occurs as a consequence of venous hypertension associated with deep vein system obstruction and venous valve dysfunction. Although there are no standardized diagnostic tests for this disease, ultrasound findings may be very useful for its diagnosis, prediction, treatment, and follow-up.

METHODS

We performed a comprehensive review of the literature available in the scientific databases PubMed and Medline until May 1, 2025, selecting 42 articles of interest, which included the main international clinical practice guidelines. We then summarized the available evidence on the usefulness of Duplex ultrasound in the evaluation of patients with PTS associated with DVT of the lower limbs.

RESULTS

Although the diagnosis of PTS is primarily based on clinical criteria, ultrasound identification of chronic post-thrombotic changes may increase the reliability of clinical diagnostic scores. Residual venous obstruction, assessed 3-6 months after diagnosis of DVT, and to a lesser extent popliteal valve reflux are associated with an increased risk of developing PTS. This finding may be relevant to guide the duration of anticoagulant therapy, but also to identify patients who benefit most from continued treatment with elastic compression stockings to reduce the risk of PTS.

CONCLUSIONS

Duplex ultrasound assessment provides complementary information to clinical manifestations in the evaluation of patients with PTS, leading to better diagnostic accuracy. Its findings might also allow predicting PTS after an episode of DVT of the lower limbs, and to optimize therapeutic management.