Table 1.
Ratings of proposed items with medians and disagreement.
| PTS diagnosis and surveillance | Median | Disagreement |
|---|---|---|
| 1- The Villalta scale is recommended for diagnosis and severity classification of PTS | 7 | No |
| 2- The Ginsberg scale is recommended for diagnosis and severity classification of PTS | 5 | Yes |
| 3- The Brandjes scale is recommended for diagnosis and severity classification of PTS | 5 | No |
| 4- The CEAP scale is recommended for diagnosis and severity classification of PTS | 5 | No |
| 5- Preexisting venous insufficiency (e.g., contralateral limb) should be taken into account for classifying PTS severity after DVT | 7 | No |
| 6- PTS should be assessed 1 month after the diagnosis of iliofemoral DVT | 4 | Yes |
| 7- PTS should be assessed 1 month after the diagnosis of popliteal or calf DVT | 4 | Yes |
| 8- PTS should be assessed 6 months after the diagnosis of iliofemoral DVT | 8 | No |
| 9- PTS should be assessed 6 months after the diagnosis of popliteal or calf DVT | 7 | No |
| 10- PTS should be assessed periodically (e.g., 6 months) and for at least 2 years since the diagnosis of proximal or calf DVT | 7 | No |
| PTS symptom mangement and prevention | Median | Disagreement |
| 1- Graduated compression stockings (GCS) or elastic bandages are recommended for symptomatic relief in acute DVT | 8 | No |
| 2- Knee length GCS (40 mmHg at the ankle) are recommended after iliofemoral DVT | 6 | No |
| 3- Thigh-length GCS (40 mmHg at the ankle) are recommended after iliofemoral DVT | 7 | No |
| 4- Knee length GCS (40 mmHg at the ankle) are recommended after popliteal or calf DVT | 7 | No |
| 5- Thigh length GCS (40 mmHg at the ankle) are recommended after popliteal or calf DVT | 4 | No |
| 6- GCS are recommended for different lengths of time according to the severity of periodically assessed PTS | 7 | No |
| 7- Catheter-directed thrombolysis, with or without mechanical thrombectomy, are appropriate in patients with iliofemoral obstruction, severe symptoms, and a low risk of bleeding | 7 | No |
| 8- Catheter-directed thrombolysis, with or without mechanical thrombectomy, are appropriate in patients with popliteal obstruction, severe symptoms, and a low risk of bleeding | 4 | No |
| PTS Treatment | Median | Disagreement |
| 1- Thigh length GCS (30–40 mmHg at the ankle) are recommended after iliofemoral DVT | 7 | No |
| 2- Knee length GCS (30–40 mmHg at the ankle) are recommended after iliofemoral DVT | 6 | No |
| 3- Thigh-length GCS (30–40 mmHg at the ankle) are recommended after popliteal or calf DVT | 3 | No |
| 4- Knee length GCS (30–40 mmHg at the ankle) are recommended after popliteal or calf DVT | 7 | No |
| 5- Compression therapy is recommended for ulcer treatment | 9 | No |
| 6- Exercise training is recommended for PTS treatment | 7 | No |
| 7- Endovascular treatment (angioplasty and/or stenting) is recommended for the treatment of severe PTS | 6 | No |
| 8- Oral anticoagulation is recommended after endovascular treatment with stenting | 7 | No |
| 9- Long term oral anticoagulation is recommended after endovascular treatment with stenting | 6 | No |
| 10- Open surgical reconstruction and hybrid operations are appropriate for the treatment of severe PTS | 4 | No |
| 11- Veno-active drugs are recommended | 6 | No |
Appropriate: panel median of 7–9, without disagreement on the final appropriateness scale: it would be considered improper care not to provide this service, and there is a reasonable chance that this procedure will benefit the patient. The benefit to the patient is not small.
Uncertain: panel median of 4–6 OR any median with disagreement; Inappropriate: panel median of 1–3, without disagreement.