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This section focusses on the complications of VTE, particularly on the management of PTS and CTEPH
PTS is the most common complication of DVT and typically causes chronic pain and swelling in the affected leg, and in severe cases can result in venous ulcers1
The exact cause of PTS is not well understood, but it may result from damage to venous valves, ultimately leading to increased venous pressure.3
Symptoms of PTS include:3
Signs of PTS include:3
CTEPH is a form of pulmonary hypertension caused by partial obstruction of the major pulmonary arteries resulting from an unresolved PE.5
Although CTEPH is a serious long-term complication of PE, it can be difficult to diagnose because clinical symptoms and signs are non-specific or absent in early CTEPH. Many of the symptoms of CTEPH are similar to those for acute PE, including:6
Without intervention, the 5-year survival rate once the mean pulmonary artery pressure reaches 40 mm Hg is about 30%.7
CTEPH is generally first identified using echocardiography and can be confirmed by right-sided heart catheterization and perfusion imaging.6
Patients with CTEPH may be managed surgically via pulmonary endarterectomy or, in those for whom this in inappropriate, lung transplantation.6 Riociguat (Adempas®, Bayer) is approved for the treatment of CTEPH in patients with inoperable or persistent/recurrent CTEPH after pulmonary endarterectomy.8 For patients who have failed on/are not suitable for the above treatment options, drugs approved for idiopathic pulmonary arterial hypertension may be useful for managing the symptoms of CTEPH.9