Improved management of the Paget-Schroetter syndrome secondary to thoracic outlet compression

Urschel, Harold C.; Razzuk, Maruf A.

doi:10.1016/0003-4975(91)90004-a

Cited by 99 publications

(49 citation statements)

References 23 publications

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“…Thrombolytic agents used with reasonable results include streptokinase, urokinase and tissue plasminogen activator [30,41,42,43,44,45,46,47,48,49,50,51]. Currently, new-generation thrombolytic agents such as alteplase and reteplase are also very frequently used [52 ](tables 4, 5).…”

Section: Investigation Of Uldvtmentioning

confidence: 99%

Upper Limb Deep Vein Thrombosis: A Literature Review to Streamline the Protocol for Management

et al. 2007

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Objective: The objective of this article is to provide up-to-date information about aetiology, pathogenesis, diagnostic modalities and treatment of upper limb deep vein thrombosis (ULDVT). Methods: Generic terms including ULDVT, axillary-subclavian DVT, and complications of central venous catheters were searched on electronic database. We analysed original studies, review articles and evaluation studies published over the last 25 years. Results: Forty-seven studies on ULDVT encompassing 2,557 patients were evaluated. The incidence of ULDVT was quoted 1–4% of the total DVT. Primary ULDVT (20% of the total) was due to activity-related venous trauma. Secondary ULDVT (80% of the total) was due to central venous catheters and malignancy. Duplex ultrasound (sensitivity 78–100% and specificity 82–100%), contrast venography (gold standard) and magnetic resonance venography were the diagnostic tools used. Pulmonary embolism (2–35%) and post-thrombotic syndrome (7–46%) were the main sequelae. Anticoagulation was the universal intervention, giving 79% symptom relief (13.2% rethrombosis rate). Thrombolysis and/or percutaneous thrombectomy were used in 38% of cases for the management of ULDVT, giving 83% symptom relief (90% recanalization rate and 9% rethrombosis rate). Surgical decompression, venous angioplasty and superior vena cava filters were the main adjunctive interventions. Conclusion: ULDVT, although rare, is associated with considerable morbidity and mortality (29–40%) due to potential risks of pulmonary embolism, post-thrombotic syndrome and loss of vascular access. Simple anticoagulation is suitable for the majority of patients. Thrombolysis/thrombectomy is often successful but less frequently used. Surgical decompression, venous angioplasty and superior vena cava filters have some role in recurrent cases. An optimal management protocol can be established using a multimodality approach.

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Section: Investigation Of Uldvtmentioning

confidence: 99%

Upper Limb Deep Vein Thrombosis: A Literature Review to Streamline the Protocol for Management

et al. 2007

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“…For Paget-Schroetter syndrome, stents seem to be of little value and are associated with a high incidence of stent fractures. 10) In conclusion, the present case shows that percutaneous interventional procedures can achieve a rapid and safe improvement in the venous circulation of patients with Paget-Schroetter syndrome. …”

Section: Discussionmentioning

confidence: 91%

“…1,2) Untreated symptomatic patients can suffer long-term disability due to venous obstruction, resulting in significant loss of occupational productivity and quality of life. 3) Systemic or catheter-directed thrombolysis followed by anticoagulation and surgical intervention has been recommended in much of the recent literature, there have been no reports of hybrid interventional treatment.…”

Section: Introductionmentioning

confidence: 99%

Clinical Usefulness of Hybrid Intervention for the Treatment of Primary Thrombosis of Axillary-subclavian Vein

Onozawa¹,

Tajima²,

Murata³

et al. 2009

Annals of Vascular Diseases

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Untreated symptomatic patients with Paget-Schroetter syndrome can suffer chronic disability due to venous obstruction, with arm swelling, pain, and early exercise fatigue. Although systemic or catheter-directed thrombolysis followed by anticoagulation and surgical intervention is recommended, there is no definite consensus about treatment. Here, we report the clinical usefulness of hybrid intervention with a combination of thrombectomy, thrombo-aspiration and balloon PTA, which has not been reported previously for this condition. These procedures were successful, and the patient has been free of symptoms for 6 years.

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“…6,24 Judicious thrombolysis followed by a course of anticoagulation has also been advocated, with surgical decompression reserved for refractory conditions. 22 In cases of external compression, such as an element of thoracic outlet syndrome or clavicular impingement, acute correction of the anatomy would be advocated by most vascular surgeons. 9,12 In their literature review that included more than 2500 patients, Sajid et al 30 found no superiority of treatment between anticoagulation therapy alone and thrombolysis for the general treatment of upper extremity DVT.…”

Section: Clinical Diagnosismentioning

confidence: 99%

“…[8][9][10] Multiple case reports and case series have documented the evolution of clinical recognition and treatment of this disorder. [4][5][6][9][10][11][12][13][14][15][16][17][18][19][20][21][22] The most common presentation is acute swelling of the dominant extremity; antecedent trauma or repetitive overhead activity has occasionally occurred. 5,6,16 Early recognition and aggressive treatment of this disorder has been recommended to avoid the long-term sequelae associated with chronic venous obstruction.…”

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confidence: 99%

Unique Treatment Regimen for Effort Thrombosis in the Nondominant Extremity of an Overhead Athlete: A Case Report

Snead

Marberry

Rowdon

2009

Journal of Athletic Training

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Objective: To advise athletic trainers on the potential for effort thrombosis to occur in nonthrowing athletes and to underscore the importance of early recognition and treatment. Background: An 18-year-old offensive lineman presented with a 1-day history of diffuse shoulder pain with no specific history of injury; swelling and erythema involved the entire left upper extremity. He was immediately referred to the team physician, who suspected deep vein thrombosis and sent the athlete to an imaging center. Duplex ultrasound was obtained on the day of presentation, and he was admitted to the hospital that evening. Differential Diagnosis: Deep vein thrombosis, thoracic outlet syndrome, shoulder tendinitis. Treatment: Anticoagulation with heparin was administered at the hospital, and he was sent home the next day on subcutaneous enoxaparin sodium, followed by a 5-mg daily dose of oral warfarin sodium. Oral anticoagulants were continued for a total of 4 weeks. The athlete began upper body lifting and was released 5 weeks postinjury to gradually return to football without restrictions. Uniqueness: Effort thrombosis is typically seen in the dominant arm of athletes, and the current treatment protocol calls for thrombolysis or surgical intervention. This athlete, whose position required repeated elevation of his arms in forward flexion, sustained the injury in his nondominant arm, was treated with anticoagulation only, and had a full return to football. At 18-month follow-up, he had no recurrence of symptoms. Conclusions: Early recognition and treatment of athletes with effort thrombosis is paramount to a successful clinical outcome and prompt return to play.

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Improved management of the Paget-Schroetter syndrome secondary to thoracic outlet compression

Cited by 99 publications

References 23 publications

Upper Limb Deep Vein Thrombosis: A Literature Review to Streamline the Protocol for Management

Upper Limb Deep Vein Thrombosis: A Literature Review to Streamline the Protocol for Management

Clinical Usefulness of Hybrid Intervention for the Treatment of Primary Thrombosis of Axillary-subclavian Vein

Unique Treatment Regimen for Effort Thrombosis in the Nondominant Extremity of an Overhead Athlete: A Case Report

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