Evaluation of a new treatment strategy for Paget-Schroetter syndrome: spontaneous thrombosis of the axillary-subclavian vein

J Vasc Surg. 1993 Feb;17(2):305-15; discussion 316-7. doi: 10.1016/0741-5214(93)90416-j.

Abstract

Purpose: The purpose of this study was to evaluate the efficacy of a staged, multimodal algorithm of therapy for durable correction of Paget-Schroetter syndrome.

Methods: Fifty consecutive patients were entered into a sequential treatment program for spontaneous axillary-subclavian vein thrombosis. Forty-three had initial thrombolytic or anticoagulant treatment followed by longer-term warfarin sodium therapy. Thirty-six (72%) underwent surgical correction of the underlying structural abnormality, and nine patients had postoperative balloon angioplasty.

Results: At the time of final evaluation, 93% of patients with a patent vein and 64% of those with an occluded vein were essentially free of symptoms. After surgical correction there were no episodes of recurrent thrombosis in a mean follow-up period of 3.1 years. Urokinase was the most effective pharmacologic agent for clot lysis (p = 0.003), and restoration of initial patency was the most significant factor in establishing final venous patency determined venographically (p = 0.0003).

Conclusions: It was concluded that a staged, multimodal approach to the Paget-Schroetter syndrome can effectively restore venous patency, reduce rethrombosis, and return normal function. The most effective sequence included transcatheter thrombolytic therapy, 3 months of anticoagulation therapy with warfarin sodium, and transaxillary first rib resection and decompression, followed by balloon angioplasty in cases of residual stricture.

MeSH terms

  • Adolescent
  • Adult
  • Angioplasty, Balloon / adverse effects
  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use
  • Axillary Vein* / diagnostic imaging
  • Axillary Vein* / surgery
  • Combined Modality Therapy
  • Female
  • Fibrinolytic Agents / adverse effects
  • Fibrinolytic Agents / therapeutic use
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Radiography
  • Subclavian Vein* / diagnostic imaging
  • Subclavian Vein* / surgery
  • Syndrome
  • Thrombectomy / adverse effects
  • Thrombolytic Therapy / adverse effects
  • Thrombosis / diagnosis
  • Thrombosis / epidemiology
  • Thrombosis / therapy*

Substances

  • Anticoagulants
  • Fibrinolytic Agents