Post-Thrombotic Syndrome Case Report – Ms. M.S.

Ms. M.S. is a 53-year-old office manager that works in a restaurant-supply facility. She is required to process a large volume of orders throughout the day resulting in extended periods of sitting at her work station. Her medical history is remarkable for degenerative arthritis in the spine and knees as well as an episode of Deep Vein Thrombosis (DVT). DVT is a condition where a blood clot in the deep veins of the legs results in pain, swelling, redness, and warmness. If left untreated, DVT can result in a potentially fatal Pulmonary Embolism where the clot breaks loose and travels to the lungs. However, as was the case with Ms. M.S., DVT can be asymptomatic. Fortunately, her condition was detected with a routine screening and successfully treated with a trial anticoagulant medication.

One year later, Ms. M.S. became aware of observable changes and unpleasant symptoms in her lower extremities. There was an aching sensation and a feeling of heaviness in her legs that worsened in the evening hours. There was also swelling in the region of the ankle and prominent varicosities at the posterior aspect of her legs. Her signs and symptoms were initially mild, however, over time she began experiencing cramping and increased swelling. Additionally, the appearance of the veins became more troubling as they increased in size and thickness. She eventually sought the care of her family physician.

Her family doctor observed the condition of her lower limbs and informed Ms. M.S. that she was experiencing the effects of compromised circulation. A referral was made to a vascular specialist to investigate whether she was experiencing benign varicose veins or if this was related to her prior DVT. A lower limb venous ultrasound was performed and it was determined there were additional blood clots in the deep veins of her leg causing other superficial veins to become distended as blood was rerouted to those without obstruction. Ms. M.S. was experiencing increased venous hypertension and was formally diagnosed with a condition termed Post-Thrombotic Syndrome (PTS). PTS occurs in patients with a history of DVT and is characterized by pain, swelling and varicose veins due to incompetence of damaged venous valves. Without appropriate management or intervention, PTS can present as skin discolouration and venous ulceration resulting from ongoing venous hypertension.

Ms. M.S. was prescribed compression stocking and was advised to keep her leg elevated to prevent blood pooling. It was emphasized that her condition can result in ominous outcomes and the compression stockings must be worn daily considering the sedentary nature of her work. She was advised on how to utilize the stockings and was informed how they will increase blood flow by exerting pressure around the leg to compensate for her compromised venous valves. She was also advised the stockings will need to be replaced as they lose their elasticity over time.

Ms. M.S. was eager to be compliant with her treatment protocol to manage her PTS. However, she found the difficulties with the compression stockings to be disconcerting. Specifically, she found it very challenging and time consuming to don them over her legs each morning and the task exacerbated her low back pain. Once in place, she found them to be very tight and uncomfortable. Ms. M.S. also found that they made her legs feel excessively hot. This was compounded by the fact that her clothing options were limited to pants and jeans as dresses or skirts would not conceal the stockings. Consequently, she found the stockings caused her legs to perspire beneath the stockings and they were becoming odoriferous with repeated usage.

Ms. M.S. continued to wear the compression stockings each day for several weeks despite the numerous inconveniences they presented to her throughout the day. However, she found that there had been very little change in the swelling or varicose veins. Accordingly, she began seeking alternative treatment solutions to manage her condition.

Through her research and inquiries with her treatment team, Ms. M.S. became aware of Mobile Compression Devices (MCDs). MCDs are portable mechanical compression devices that cyclically inflate around the lower extremities to simulate the pumping action of the circulatory system. In comparison to compression stockings, MCDs can generate higher levels of pressure to mobilize stagnant deoxygenated blood from the lower limbs resulting in greater levels of clinical efficacy. However, Ms. M.C. was warned of their cost and complexity. Furthermore, the inflation of the bladders can lead to an unpleasant sensation that could potentially interfere with compliance. Fortunately, she discovered a unique MCD called the Venowave. In contrast to other MCDs, the Venowave was affordable and simple to operate. It is powered by two AA batteries in a self-contained unit that is strapped to the bulk of the calf on an adjustable neoprene sleeve. The Venowave generates pressure through a patented waveform motion thereby avoiding discomfort or intolerance while receiving compression therapy. It was determined in a hospital-based research study that patients found the Venowave very comfortable during prolonged treatment periods. Furthermore, the Venowave was also clinically proven for patients with PTS in a subsequent research study. Ms. M.S. obtained a Venowave device with the hopes of mitigating the difficulties she was experiencing with her current PTS management.

Upon initiating her first trail with the Venowave device, Ms. M.S. was surprised at how lightweight and comfortable it was. She felt as though the device was delivering a massage to the back of her calf. She wore the Venowave daily throughout her working hours and evenings and charged the batteries at night. Within a period of weeks, the swelling and varicosities in her legs had been markedly reduced. She was no longer experiencing pain or the sensation of heaviness in her legs at the end of the day. Her treating physician reported that the clinical signs and symptoms of PTS were resolving with the Venowave. These outcomes had not been observed with compression stockings.

Ms. M.S. continues to utilize the Venowave as a preventative measure for thrombotic events and remains free of the pain and swelling associated with PTS. Due to its unique and innovative design, the Venowave device provides an affordable, comfortable, simple, and effective means of treating those with PTS and other conditions that arise from the effects of reduced lower limb circulation.

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