title: Pharmacomechanical Thrombectomy in Paget-Schroetter Syndrome.
abstract: OBJECTIVE
  The purpose of the study was to evaluate feasibility of pharmacomechanical thrombectomy (PMT) in the treatment of Paget-Schroetter syndrome (PSS) followed by thoracoscopic or open surgical decompression of the subclavian vein.
  
  
  METHODS
  Twenty-two out of 27 consecutive patients with PSS received PMT using the Trellis-8 peripheral infusion system (Covidien) between 2010 and 2014. Subsequent surgery was performed in 18 of those patients, 9 patients were treated with thoracoscopic, 7 patients with subclavicular, and 2 patients with transaxillary first rib resection, 4 patients were treated with PMT and anticoagulation alone. Technical success, complications, and patency were registered.
  
  
  RESULTS
  PMT was successful in 21 (95 %) patients; 1 patient with unsatisfactory lysis received further catheter-directed thrombolysis, which, however, did not improve the result. The mean endovascular procedure time was 105 ± 33 min (range 70-200 min), and the required median amount of thrombolytic agent was 500,000 international unit (IU; range 250,000-1,000,000 IU). Adjunctive balloon venoplasty and aspiration were used in 18 (82 %) and 7 (32 %) cases, respectively. One patient had an intimal tear of the subclavian vein that was discovered and repaired during surgery. There were no other complications related to the endovascular procedure. At follow-up, 18 of 21 patients (86 %) with follow-up imaging available had patent subclavian vein, and all except 1 of the 22 patients were asymptomatic. The mean follow-up time was 25 ± 17 months.
  
  
  CONCLUSIONS
  In experienced hands, PMT is effective for early thrombus removal in PSS. Surgical decompression must be considered after PMT.
authors.affiliation: Heart Center, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland. jkarkkai@gmail.com.|Department of Surgery, Kuopio University Hospital, Kuopio, Finland. jkarkkai@gmail.com.
authors.forename: Jussi M
authors.initials: JM
authors.lastname: Kärkkäinen
authors.affiliation: Department of Surgery, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Henrik
authors.initials: H
authors.lastname: Nuutinen
authors.affiliation: Heart Center, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland.
authors.forename: Teemu
authors.initials: T
authors.lastname: Riekkinen
authors.affiliation: Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.
authors.forename: Eero
authors.initials: E
authors.lastname: Sihvo
authors.affiliation: Department of Surgery, North Karelia Central Hospital, Joensuu, Finland.
authors.forename: Johanna
authors.initials: J
authors.lastname: Turtiainen
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Petri
authors.initials: P
authors.lastname: Saari
authors.affiliation: Heart Center, Kuopio University Hospital, PL 100, 70029, Kuopio, Finland.
authors.forename: Kimmo
authors.initials: K
authors.lastname: Mäkinen
authors.affiliation: Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.
authors.forename: Hannu
authors.initials: H
authors.lastname: Manninen
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013350:Subclavian Vein / Q000000981:diagnostic imaging / Q000601:surgery; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D056824:Upper Extremity Deep Vein Thrombosis / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents
keywords: Mechanical thrombectomy; Paget–Schroetter syndrome; Pharmacomechanical thrombectomy; Pulmonary embolism; Subclavian vein thrombosis; Thoracic surgical decompression; Thoracoscopic first rib resection