[The use of intravascular nitinol stents in the treatment of subclavian vein compression for thoracic outlet syndrome].
OBJECTIVE
The purpose of this study is to evaluate the multimodal treatment (thrombolysis, anticoagulation and surgical decompression) of subclavian-axillary vein thrombosis (Paget-Schroetter syndrome) and possibility of shortening of time of therapy.


METHODS
In this paper 23 patients with Paget-Schroetter syndrome in Department of Vascular, General and Transplantological Surgery is presented. Thrombolysis with rt-PA, anticoagulation with heparin and intra venous angioplasty with the use intravascular stent, and operation with resection of the first rib in the treatment of subclavian vein thrombosis was used. During the follow up period the patients were divided into two groups: group I (13 patients) with traditional surgical decompression after 3-4 months (potential risk of hemorage) and group II (10 patients) with early surgical treatment (median 8 days). Long-term follow-up was obtained by chart review and asking patients to complete the DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire that was developed by the American Academy of Orthopedic Surgeons.


RESULTS
Complete revascularization with venous thrombolysis was achived in all patients. Decompresion with transaxillary resection of first rib and venous revascularization were performed in the same procedure in all patients. Statistical difference were not found in both groups. Most patients report no disability of upper limb at work and sport activity.


CONCLUSIONS
Multimodal treatment of Paget-Schroetter syndrome (thrombolysis, the use of intravascular stents and early thoracic outlet decompression) can be used as a optimal of therapeutic method to subclavian vein thrombosis. The advantages of immediate surgical treatment are a promotion of rapid resumption of athletic activities.
Pupka
Artur
A
Katedra i Klinika Chirurgii Naczyniowej, Ogólnej i Transplantacyjnej AM we Wrocławiu. apupka@chirn.am.wroc.pl
Szyber
Przemysław P
PP
Garcarek
Jerzy
J
Szyber
Piotr
P
D000293:Adolescent; D000328:Adult; D000497:Alloys; D000800:Angioplasty, Balloon / Q000379:methods; D001367:Axillary Vein / Q000000981:diagnostic imaging / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D002573:Cervical Rib Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D010690:Phlebography / Q000379:methods; D012189:Retrospective Studies; D015607:Stents; D013350:Subclavian Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D013577:Syndrome; D013901:Thoracic Outlet Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy
D000497:Alloys; C013616:nitinol; D010959:Tissue Plasminogen Activator