A 77-year-old woman was admitted to a regional hospital Trauma Intensive Care Unit (ICU) following a high-speed motor vehicle accident with multiple injuries, including bilateral pelvic fractures, left-sided rib fractures, left pneumothorax, a right orbital fracture, and a concussion. Her prolonged hospital course was complicated by bilateral common femoral DVTs despite compression stockings and prophylactic dose subcutaneous unfractionated heparin. She was initiated on intravenous unfractionated heparin as a “bridge” to oral anticoagulation with warfarin. She was eventually discharged home with a plan for 6 months of anticoagulation with warfarin. At her 6 month follow-up visit with her Primary Care Physician, she continued to complain of lower extremity edema, “heaviness,” and “brownish-red discoloration” of her legs around the ankles. On physical examination, she had 2+ pitting edema bilaterally, brown hyperpigmentation above the right medial malleolus, and a reddish hue to her lower legs (Fig. 12.1). Her Primary Care Physician ordered bilateral venous ultrasounds to evaluate for new or residual DVT. Venous ultrasounds demonstrated partial non-compressibility of the bilateral common femoral veins (Fig. 12.2) and small channels of color Doppler flow consistent with partially recanalized chronic-appearing DVT (Fig. 12.3). She was continued on anticoagulation with warfarin and referred to Vascular Medicine clinic for further evaluation. The Vascular Medicine provider diagnosed her with post-thrombotic syndrome (PTS) on the basis of her persistent symptoms despite 6 months of therapeutic anticoagulation for DVT. She was prescribed thigh high, 30–40 mmHg, graduated compression stockings to be used daily. Over the course of the next few months, the patient noted a marked improvement in her lower extremity edema and discomfort.