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Post thrombotic syndrome (PTS) is a common chronic complication of deep venous thrombosis (DVT). PTS has a negative impact on quality of life. Patients with a more serious form of this syndrome have increased rates of sick leave and incur increased medical costs. The underlying processes leading to PTS are not yet fully understood. Pressure increases in the deep-venous system, resulting in venous hypertension. Venous hypertension is the cause of the most important symptoms of PTS: pain, oedema and skin abnormalities. Compression therapy reduces oedema and pain in patients in the acute phase following DVT. Based on convincing results from randomised trials, elastic compression therapy was recommended for patients with DVT for many years, in order to prevent venous hypertension and PTS. Recent studies have led to discussion on the added value of elastic compression.

Despite optimal treatment of acute deep-vein thrombosis (DVT) there is a great chance of recurrent DVT and development of post-thrombotic syndrome (PTS) in the long term. The degree of spontaneous recanalization differs per patient and per thrombus location. 90% of all femoropopliteal occlusions will fully recanalize within 1 year; however, in the case of an iliofemoral thrombosis, recanalization occurs only in a minority of cases. Post-thrombotic complications occur more often following iliofemoral thrombosis, and the chance of recurrent thrombosis is greater than following thrombosis in a more distal location. An anatomical variation or abnormality also more often underlies an iliofemoral thrombosis. It is important to identify patients with a greater chance of developing PTS promptly and to treat them in order to prevent post-thrombotic damage. There are still insufficient trial data available to implement catheter-directed thrombolysis as standard therapy for iliofemoral thrombosis