Evaluation of a new treatment strategy for Paget-Schroetter syndrome: spontaneous thrombosis of the axillary-subclavian vein.
OBJECTIVE
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.
Machleder
H I
HI
Department of Surgery, UCLA Medical School 90024-6904.
D000293:Adolescent; D000328:Adult; D000800:Angioplasty, Balloon / Q000009:adverse effects; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001367:Axillary Vein / Q000000981:diagnostic imaging / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013350:Subclavian Vein / Q000000981:diagnostic imaging / Q000601:surgery; D013577:Syndrome; D017131:Thrombectomy / Q000009:adverse effects; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013927:Thrombosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*
D000925:Anticoagulants; D005343:Fibrinolytic Agents