title: Long-term functional outcomes and subclavian vein patency in patients undergoing thoracic outlet surgery for Paget-Schroetter Syndrome.
abstract: BACKGROUND
  To assess subclavian vein (SCV) patency and long-term functional outcomes following surgical decompression of the thoracic outlet (SDTO) for Paget-Schroetter Syndrome (PSS).
  
  
  METHODS
  Between January 1978 and January 2013, we identified 33 patients with PSS who underwent SDTO. Demographic, clinical and radiological data were extracted from electronic databases and patient records. All patients were invited to update their follow-up data during dedicated outpatient visits between October and December 2013. Outcome measures included long-term SCV patency and clinical success rates during follow-up. Clinical success was defined as the combined absence of functional symptoms and patient's ability to maintain normal professional activities at final follow-up. The QuickDASH score was also determined.
  
  
  RESULTS
  The study population comprised 17 men and 16 women (mean age 34 years; range: 14-53 years) with PSS. Diagnosis was reached by venography (29 cases) or duplex scan (4 cases). SDTO was performed via the transaxillary route (25 cases) or using the combined supra-infraclavicular approach (8 cases). The procedure was carried out within 10 days in 13 patients (early-group), and between 30 to 120 days in the remaining 20 patients (late-group). The former had SCV recanalization obtained actively by thrombolysis (3 cases), thrombectomy (9 cases) or endovenectomy followed by patch venoplasty (1 case). The latter were maintained under chronic oral anticoagulation to allow SCV recanalization. There was neither postoperative death nor major bleeding complications. At a median follow-up of 240 months, 11 SCV remained patent in the early group, while in the other there was 3 re-occlusions, 4 residual stenoses and 5 chronic SCV occlusions. Clinical success was achieved in 73% of patients for the whole cohort, but was significantly better in patients operated on in the early stages (100% vs. 55%; P=0.005). The mean Quick Disabilities of the Arm, Shoulder, and Hand Score was 3.5 (95% CI: 1.5-5.4) in the early-group and 17.3 (95% CI: 8.4-26.2) in the late-group (P=0.01).
  
  
  CONCLUSIONS
  Our data shows that long-term functional outcomes and SCV patency remained better in PSS patients who underwent early SDTO and active SCV recanalization techniques.
authors.affiliation: University of Nice-Sophia-Antipolis, Graduate School of Medicine, Nice, France.|Department of Vascular Surgery, Saint Roch Hospital, University Hospital of Nice, Nice, France.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Elixène
authors.affiliation: University of Nice-Sophia-Antipolis, Graduate School of Medicine, Nice, France.|Department of Vascular Surgery, Saint Roch Hospital, University Hospital of Nice, Nice, France.
authors.forename: Nirvana
authors.initials: N
authors.lastname: Sadaghianloo
authors.affiliation: University of Nice-Sophia-Antipolis, Graduate School of Medicine, Nice, France.|Department of Vascular Surgery, Saint Roch Hospital, University Hospital of Nice, Nice, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Mousnier
authors.affiliation: University of Nice-Sophia-Antipolis, Graduate School of Medicine, Nice, France.|Department of Vascular Surgery, Saint Roch Hospital, University Hospital of Nice, Nice, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Brizzi
authors.affiliation: University of Nice-Sophia-Antipolis, Graduate School of Medicine, Nice, France.|Department of Vascular Surgery, Saint Roch Hospital, University Hospital of Nice, Nice, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Declemy
authors.affiliation: University of Nice-Sophia-Antipolis, Graduate School of Medicine, Nice, France - hassen-khodja.r@chu-nice.fr.|Department of Vascular Surgery, Saint Roch Hospital, University Hospital of Nice, Nice, France.
authors.forename: Réda
authors.initials: R
authors.lastname: Hassen-Khodja
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D016208:Databases, Factual; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D004185:Disability Evaluation; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects; D010690:Phlebography; D020127:Recovery of Function; D012008:Recurrence; D012189:Retrospective Studies; D013350:Subclavian Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D056824:Upper Extremity Deep Vein Thrombosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014654:Vascular Patency; D055815:Young Adult
chemical_list: D000925:Anticoagulants