Villalta Score for Post-thrombotic Syndrome (PTS)

Villalta Calculator

Pain

Cramps

Heaviness

Paresthesia

Pruritus

Edema

Skin Induration

Hyperpigmentation

Redness

Venous Ectasia

Pain on Calf Compression

Venous Ulcer

Villalta Score: –

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Stratifies severity of post-thrombotic syndrome in lower extremity DVT.

Why Use

PTS can be seen in up to half of patients with lower extremity DVT within 2 years. This score both diagnoses and grades severity of PTS.

When to Use

Use in patients with lower extremity signs and symptoms related to DVT (e.g. swelling, discoloration, ulceration) and clinical suspicion for post-thrombotic syndrome (PTS). Should defer PTS diagnosis until after the acute DVT phase has passed (3–6 months).

Formula

Addition of the selected points: Variable Points Symptoms Pain Absent 0 Mild 1 Moderate 2 Severe 3 Cramps Absent 0 Mild 1 Moderate 2 Severe 3 Heaviness Absent 0 Mild 1 Moderate 2 Severe 3 Paresthesia Absent 0 Mild 1 Moderate 2 Severe 3 Pruritus Absent 0 Mild 1 Moderate 2 Severe 3 Clinical signs Pretibial edema Absent 0 Mild 1 Moderate 2 Severe 3 Skin induration Absent 0 Mild 1 Moderate 2 Severe 3 Hyperpigmentation Absent 0 Mild 1 Moderate 2 Severe 3 Redness Absent 0 Mild 1 Moderate 2 Severe 3 Venous ectasia Absent 0 Mild 1 Moderate 2 Severe 3 Pain on calf compression Absent 0 Mild 1 Moderate 2 Severe 3 Venous ulcer* Absent - Present Severe PTS *Note: presence of venous ulcer automatically confers the highest severity (severe). For scores <15 before venous ulcer is accounted for, final score is 15.

Pearls / Pitfalls

Venous ulceration indicates severe PTS and automatically confers a score of ≥15.

Management

May consider conservative treatment, e.g. elastic compression stockings (ECS), for mild to moderate PTS. In patients with moderate to severe PTS uncontrolled with ECS alone, may consider intermittent compression devices or pneumatic compression sleeve units. For lifestyle limiting refractory and/or severe PTS, may consider endovascular treatment.

Critical Actions

Clinical severity, multidisciplinary evaluation, and patient preference should guide management.

More Information

Interpretation: Villalta Score PTS diagnosis PTS severity 0-4 Absent - 5-9 Present Mild 10-14 Moderate ≥15, or presence of venous ulcer* Severe *Patients with venous ulcer after DVT and Villalta score of <15 are assigned a score of 15 according to International Society on Thrombosis and Haemostasis guidelines ( Kahn 2009 ).