Non-Operative Management of Paget-Schroetter Syndrome: A Single-Center Experience.
OBJECTIVE
The preponderance of existing literature for the treatment of Paget-Schroetter syndrome (PSS) advocates clot lysis followed by thoracic outlet decompression (TOD). We postulate that long-term anticoagulation has equal outcomes to more invasive and costly surgical intervention, and review our experience with non-operative management of PSS.


METHODS
A retrospective review was conducted, examining patients between 1994-2014. Forty patients were identified with PSS, and 27 of these patients had sufficient follow-up for this analysis. Charts were reviewed for details of clinical presentation, disease course, interventions, duration of oral anticoagulation, ultrasound reports, and symptoms at long-term follow-up.


RESULTS
With a mean follow-up of 54.3 months, 23/27 patients (85%) were asymptomatic after non-operative therapy. In this cohort, 16/27 patients (59%) underwent catheter-directed thrombolysis. Average treatment course with oral anticoagulation was 8.6 months. Four patients (15%) remained symptomatic at follow-up. Two patients (7%) underwent thoracic outlet decompression at another institution, with good results. At least partial recanalization of vessels was documented in 25/27 patients (93%), although recanalization did not correlate with symptoms at long-term follow-up.


CONCLUSIONS
Based upon equivalent functional results, non-operative management appears to offer similar outcomes for some patients with PSS. We propose a patient-tailored approach to the treatment of PSS, in which patients presenting acutely undergo catheter-directed thrombolysis, followed by a 6-12 month course of oral anticoagulation. Persistent symptoms, recurrent disease, lengthy duration of symptoms prior to diagnosis, and identifiable structural abnormalities may be factors predictive of poor outcomes after non-operative intervention.
Selena G
SG
Goss
Sean D
SD
Alcantara
George J
GJ
Todd
Dept of Vascular Surgery, St. Luke's-Roosevelt Hospital Center, 1090 Amsterdam Avenue, Suite 7A, New York, NY 10025 USA. jlantis@chpnet.org.
John C
JC
Lantis
D000284:Administration, Oral; D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D000072700:Conservative Treatment / Q000009:adverse effects / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D000069451:Long Term Adverse Effects / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D012189:Retrospective Studies; D020379:Risk Adjustment; D063189:Symptom Assessment / Q000379:methods / Q000706:statistics & numerical data; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000191:economics / Q000379:methods; D014481:United States; D056824:Upper Extremity Deep Vein Thrombosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy
D000925:Anticoagulants