Postthrombotic Syndrome: Classification

Chronic venous insufficiency (CVI) in postthrombotic syndrome can be classified as follows.

According to Widmer et al, three stages are distinguished

Widmer stage Description
I
  • Swelling of the legs in the evening, reversible edema (water retention)/ankle edema overnight.
  • Local vasodilatation (spider veins) in the ankle region and above the arch of the foot.
  • Corona phlebectatica – appearance of dark blue skin veins at the edge of the foot (= perimalleolar vein drawing).
II Persistent swelling of the legs (= lower leg edema) with changes in the skin such as:

  • Atrophy blanche (capillaritis alba) – small white areas of mostly coarse, scarred consistency, which occur preferentially in the area of the lower leg or upper ankle joint.
  • Hyperpigmentation (increased pigmentation) of the skin
  • Lipodermatosclerosis (dermatoliposclerosis) – increase in connective tissue and reduction of the subcutaneous fat layer, especially in the area of the ankle.
  • Purpura jaune d’ocre – orange-brown pigmentation in the ankle / lower leg area caused by hemosiderin deposition.
  • Stasis dermatitis – chronic form of eczema, usually localized on both sides of the distal lower legs (= eczematization: frequently itchy stasis eczema).
  • Cyanotic skin – purple to bluish discoloration of the skin.
III
  • Ulcus cruris venosum (venous leg ulcer (“open leg”) that occurred as a result of advanced venous disease) or scar as a secondary condition

Villalta score for clinical classification of postthrombotic syndrome (PTS).

Subjective symptoms/morphological changes None Mild Medium Heavy
Subjective symptoms
Pain 0 points 1 point 2 points 3 points
Cramps 0 points 1 point 2 points 3 points
Feeling of heaviness 0 points 1 point 2 points 3 points
Paresthesias (paraesthesia) 0 points 1 point 2 points 3 points
Morphological changes
Edema (swelling; water retention) 0 points 1 point 2 points 3 points
Induration (hardening) 0 points 1 point 2 points 3 points
Paresthesias (paraesthesia) 0 points 1 point 2 points 3 points
Pigmentation 0 points 1 point 2 points 3 points
Redness 0 points 1 point 2 points 3 points
Pain during calf compression 0 points 1 point 2 points 3 points
Venous ectasia (sac-like dilatation of veins). 0 points 1 point 2 points 3 points
Presence of a leg ulcer (ulcer of the lower leg) Yes/No

Villalta score evaluation

Score Score
0-4 No PTS
5-9 Mild PTS
10-14 Moderate PTS
14 or leg ulcer Severe PTS