SURGERY in POST-THROMBOTIC SYNDROME: UPDATE and PERSPECTIVES

For many angiologists and vascular surgeons, the post-thrombotic syndrome has to be managed by non interventional treatment. In absence of controlled randomized studies one must nevertheless considers results provided by surgical cases series. Surgical treatments address mainly to perforator incompetence and deep venous insufficiency (reflux and/or obstruction). The outcome of subfascial endoscopic perforator surgery in post-thrombotic syndrome is ambivalent. Ballooning and stoning in iliocaval obstruction has provided excellent results in terms of potency. Clinical outcome is pretty good but variable according to the symptom or sign considered. In deep venous reflux treated by transposition and transplantation, clinical improvement and valve competence are estimated front 46 go to 75 % and from 33 % to 79 % respectively at 5-year follow-up according to Maleti's technique. Neovalve construction has provided better results. Surgical treatment in post-thrombotic syndrome should be considered in severe oedema or recurrent ulcer after failure of conservative treatment. In the future, new investigations will provide better insight of the post-thrombotic syndrome and endovascular methods will develop.