Paget-Schroetter syndrome: what is the best management?
BACKGROUND
The evaluation of 312 extremities in 294 patients with Paget-Schroetter syndrome (effort thrombosis of the axillary-subclavian vein) over 30 years provides the basis for optimal management determination.


RESULTS
Group I (35 extremities) was initially treated with anticoagulants only. Twenty-one developed recurrent symptoms after returning to work, requiring transaxillary resection of the first rib. Thrombectomy was necessary in eight. Group II (36 extremities) was treated with thrombolytic agents initially, with 20 requiring subsequent rib resection after returning to work. Thrombectomy was necessary only in four. Of the most recent 241 extremities (group III), excellent results accrued using thrombolysis plus prompt first rib resection for those evaluated during the first month after occlusion (199). The results were only fair for those if seen later than 1 month (42).


CONCLUSIONS
An early diagnosis (less than 1 month), expeditious thrombolytic therapy, and prompt first rib resection are critical for the best results.
Urschel
H C
HC
Division of Thoracic and Cardiovascular Surgery, The University of Texas Southwestern Medical School and Baylor University Medical Center, Dallas, USA. urschel1@airmail.net
Razzuk
M A
MA
D000293:Adolescent; D000328:Adult; D001367:Axillary Vein / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion; D012008:Recurrence; D012272:Ribs / Q000601:surgery; D013350:Subclavian Vein / Q000601:surgery*; D013577:Syndrome; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000209:etiology / Q000601:surgery*