Combined non-surgical treatment for Paget–Schröetter syndrome: a case report

Abstract

BackgroundPaget–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.Case presentationThis 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.ConclusionCombined 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.

Paget‐Schroetter syndrome from manual handling at work: Case report and review of the literature

“…In this literature review, there was an association between PSS and repetitive hyper‐abduction or external rotation involving the shoulders. We found associations of PSS with various activities using the shoulders including sports like baseball, 17,35 swimming, 10 and judo 11 as well as occupations such as carpentry, 37 photography, 15 furniture lifting, 40 waiter, 23 and kebab chef 34 . This is consistent with our patient's described physical activities at work which involved frequent luggage loading and unloading.…”

“…The majority of the cases were male (35 males and 10 females) which was consistent with previous reviews. Also, we found indications that the right arm is more often affected than the left or both, as we found 26 cases involving the right arm, 9–34 15 cases involving the left, 12,35–48 and 4 cases involving both arms 49–52 . These findings may be a simple reflection of the fact that the majority of the population are right‐handed and so it is more likely that the right arm is used more and therefore more susceptible.…”

Upper Extremity Deep Venous Thrombosis: Etiologies, Diagnosis, and Updates in Therapeutic Strategies

“…25,26 Physical therapy and sleeve compression can be adjunctive conservative treatments. 27 On the other hand, observation, anticoagulation, and removal of thrombogenic stimulus can be sufficient for catheter-related and other secondary causes of UEDVT. ACCP recommends anticoagulation if DVT involves axillary or more proximal veins.…”

Imaging of venous compression syndromes

“…Refraining from surgery altogether has been reported, although data on long-term DVT recurrence are not available (51).…”