vascular

Villalta Score for Post-Thrombotic Syndrome (PTS)

Clinical scoring tool for diagnosis and severity grading of post-thrombotic syndrome (PTS) following deep vein thrombosis (DVT). 5 patient symptoms + 6 clinician signs, each scored 0–3. Total 0–33. Score ≥5 = PTS; score ≥15 or presence of ulcer = severe PTS.

Pain (patient-reported)*

Cramps (patient-reported)*

Heaviness (patient-reported)*

Paraesthesia / Tingling (patient-reported)*

Pruritus / Itching (patient-reported)*

Pretibial oedema (clinician sign)*

Skin induration (clinician sign)*

Hyperpigmentation (clinician sign)*

Redness / Erythema (clinician sign)*

Venous ectasia / dilated superficial veins (clinician sign)*

Calf tenderness (clinician sign)*

Venous ulcer (active) — clinician sign*

Score interpretation

No PTS 0–4

Villalta 0–4 — no post-thrombotic syndrome

→ No PTS; continue standard post-DVT care; compression stockings 2 years post-DVT per standard guidance; anticoagulation duration review; reassess Villalta at 3 and 6 months post-DVT; consider thrombophilia testing for unprovoked DVT

Mild PTS 5–9

Villalta 5–9 — mild post-thrombotic syndrome

→ Graduated compression stockings (Class II, 20–30 mmHg); leg elevation; regular exercise; weight optimisation; skin care; reassess Villalta every 6 months; vascular surgery or vascular medicine review if progressive; no invasive intervention typically required at this stage

Moderate PTS 10–14

Villalta 10–14 — moderate post-thrombotic syndrome

→ Class II–III compression stockings; vascular medicine/surgery referral; consider venous duplex ultrasound to assess chronic venous insufficiency pattern; wound care if skin breakdown; physiotherapy; intermittent pneumatic compression for intractable oedema; catheter-directed thrombolysis data retrospectively suggests early intervention for iliofemoral DVT reduces PTS severity

Severe PTS / Ulcer 15–99

Villalta ≥15 OR active venous ulcer — severe PTS

→ Urgent vascular surgery or venous specialist referral; active venous ulcer → tissue viability referral; multilayer compression bandaging for ulcer; wound care; duplex ultrasound; consider endovascular intervention (stenting for iliac obstruction); anticoagulation optimisation; manage venous hypertension; significant QoL impact — occupational therapy; psychological support

Interpretation bands for the Villalta Score. Apply clinical judgement and local guidance.

References

Villalta S et al. Assessment of validity and reproducibility of a clinical scale for the post-thrombotic syndrome. Haemostasis. 1994;24(suppl 1):158a.
Kahn SR et al. Measurement properties of the Villalta scale to define and classify the severity of the post-thrombotic syndrome. J Thromb Haemost. 2009;7(6):884–888.

Curated clinical cross-links plus same-class fallbacks.

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

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