Long-term results in patients treated with thrombolysis, thoracic inlet decompression, and subclavian vein stenting for Paget-Schroetter syndrome.
OBJECTIVE
In an effort to minimize long-term disability related to effort thrombosis of the subclavian vein, selected patients were treated with thrombolysis, thoracic inlet decompression, percutaneous transluminal angioplasty (PTA), and subclavian vein stenting. We evaluated the long-term outcomes of patients treated with this algorithm.


METHODS
Between 1994 and 2000, 23 patients were evaluated with effort thrombosis of the subclavian vein. Thrombolysis was instituted on an average of 9.4 days (range, 1-30 days) after initial onset of symptoms. Average time to clot lysis was 34 hours (range, 12-72 hours). After immediate supraclavicular thoracic inlet decompression, all patients underwent PTA. Fourteen patients with residual vein stenosis (>50%) after PTA underwent stenting of the subclavian vein. Complications in this series included three wound hematomas that required drainage in two patients and one subpleural hematoma that required thoracotomy for decompression.


RESULTS
All patients who underwent PTA are patent, with a mean follow-up of 4 years (range, 2-6 years). In the veins treated with stents, 9 of 14 veins are patent, with a mean follow-up of 3.5 years (range, 1-6 years). Two veins had early occlusions (2 days); two veins occluded at 1 year; and seven veins occluded at 3 years. Three of the patients (including those patients who experienced the early failed procedures) were later identified with factor V Leiden. Early failures also had clot extending into the brachial vein.


CONCLUSIONS
Patients with short-segment venous strictures after successful lysis and thoracic outlet decompression may safely be treated with subclavian venous stents and can expect long-term patency.
Kreienberg
P B
PB
Institute for Vascular Health and Disease, Albany Medical College, NY 12208, USA.
Chang
B B
BB
Darling
R C
RC
Roddy
S P
SP
Paty
P S
PS
Lloyd
W E
WE
Cohen
D
D
Stainken
B
B
Shah
D M
DM
D020016:Activated Protein C Resistance / Q000097:blood / Q000150:complications; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D015444:Exercise; D005165:Factor V / Q000032:analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D015607:Stents; D013350:Subclavian Vein; D013577:Syndrome; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
C095381:factor V Leiden; D005165:Factor V