Combined non-surgical treatment for Paget-Schröetter syndrome: a case report.
BACKGROUND
Paget-Schröetter syndrome is an uncommon form of venous thrombosis, which is related to thoracic outlet syndrome. Axillary-subclavian vein thrombosis typically presents in healthy young adults. We present this case of particular interest because it indicates that a combined treatment involving thrombolysis, anticoagulation therapy, rehabilitation, and elastic compression sleeves can be a valid non-surgical alternative for some patients with Paget-Schröetter syndrome.


METHODS
This report describes a case of a 38-year-old white woman, a swimmer, who presented with a sudden episode of swelling and pain in her right upper extremity. After duplex ultrasound diagnosis of venous thrombosis, computed tomography (CT) showed extrinsic compression of the vessel. Catheter-directed thrombolysis was performed in the first 24 hours, followed by anticoagulant therapy with bemiparin at a dose of 7500 IU/24 hours for the first week, and then reduced to 3500 IU/24 hours for the next 3 months. After treatment there was restoration of her venous flow and she returned to work 2 weeks later. Anticoagulant treatment was continued for 3 months; decompression surgery was not performed. At 6 months she was asymptomatic.


CONCLUSIONS
Combined treatment involving thrombolysis, anticoagulant therapy, rehabilitation, and elastic compression sleeves may be a valid non-surgical alternative for a selected subset of patients with Paget-Schröetter syndrome.
Department of Angiology, Vascular and Endovascular Surgery, Hospital Universitario Doctor Peset, Avenida de Gaspar Aguilar, 90, 46017, Valencia, Spain. gemma.ef@gmail.com.
Gemma
G
Edo Fleta
Department of Angiology, Vascular and Endovascular Surgery, Hospital Universitario Doctor Peset, Avenida de Gaspar Aguilar, 90, 46017, Valencia, Spain.
Álvaro
Á
Torres Blanco
Department of Angiology, Vascular and Endovascular Surgery, Hospital Universitario Doctor Peset, Avenida de Gaspar Aguilar, 90, 46017, Valencia, Spain.
Francisco
F
Gómez Palonés
Department of Angiology, Vascular and Endovascular Surgery, Hospital Universitario Doctor Peset, Avenida de Gaspar Aguilar, 90, 46017, Valencia, Spain.
Eduardo
E
Ortiz Monzón
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000379:methods; D058128:Compression Bandages; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000628:therapy*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; C411345:bemiparin
Anticoagulation; Paget–Schröetter syndrome; Thoracic outlet; Thrombolysis; Thrombosis