{"doi":"10.1161/circulationaha.120.052451","title":"The Open Vein Hypothesis and Postthrombotic Syndrome","abstract":"ostthrombotic syndrome (PTS) is the most common long-term complication of acute lower extremity deep vein thrombosis (DVT), and prospective data suggest that 20% to 50% of individuals develop some manifestation of PTS after DVT. 1 Symptoms of PTS include limb pain, heaviness, fatigue, edema, itching, and venous claudication. After acute DVT, up to 10% of individuals will develop venous ulcers, the most severe manifestation of PTS. 2 It is not surprising that PTS is associated with a poor quality of life and dramatically increased health care costs. Acute DVT obstructs venous outflow while also causing vein dilation and disrupting normal venous valve function. These changes may persist beyond the acute phase and lead to chronic venous insufficiency, inflammation, and venous hypertension, all of which are key to the development of PTS. Patient factors associated with increased risk of PTS include obesity, advanced age, and recurrent ipsilateral DVT. The extent of DVT, in particular, in the iliofemoral venous segment, is also associated with a heightened risk of PTS. lthough awareness, detection, and treatment of DVT have dramatically improved in recent decades, effective prevention and treatment of PTS is limited. Graduated compression stockings are often used after acute DVT to reduce soft tissue edema and venous hypertension; however, in a randomized controlled trial, they did not reduce the incidence of PTS compared with placebo stockings. 6 A variety of venotonic drugs, such as micronized flavonoid fractions 7 and horse-chestnut seed extract, 8 have shown modest improvements in some PTS symptoms. These drugs have been tested only in small studies with unknown long-term benefits and unclear efficacy in preventing PTS.","journal":"Circulation","year":2021,"id":213682,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":16,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9659,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":51564,"name":"Joshua A. Beckman","orcid":"0000-0001-8332-8439","position":1,"is_corresponding":false},{"id":232624,"name":"Aaron W. Aday","orcid":"0000-0001-6243-3432","position":0,"is_corresponding":true}],"reference_count":17,"raw_metadata":null,"created_at":"2026-07-18T23:52:36.886828Z","pmid":"33750208","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}