Long-term results in patients treated with thrombolysis, thoracic inlet decompression, and subclavian vein stenting for Paget-Schroetter syndrome

Abstract

Patients with short-segment venous strictures after successful lysis and thoracic outlet decompression may safely be treated with subclavian venous stents and can expect long-term patency.

Venous compression syndromes: clinical features, imaging findings and management

“…A contrast venogram is the standard means of determining the anatomy and can be carried out in preparation for interventions such as catheter-directed thrombolysis and percutaneous transluminal angioplasty (PTA) [15,16]. The goal of venography is to evaluate the presence of stenosis or compression of the subclavian vein that may be better depicted with changing the arm position and to identify the chest wall and neck collaterals, the presence of which usually signifies the chronic nature of venous occlusion.…”

Life-threatening acute and chronic thromboembolic pulmonary hypertension and subclavian vein thrombosis

“…A multimodal therapeutic approach consisting of early thrombolysis (local or systemic) followed by systemic anticoagulation prior to surgical thoracic outlet decompression (first rib resection) has recently been shown to yield outcomes superior to more conservative therapy. 3,20 The use of subclavian angioplasty and stenting following surgical decompression may further improve outcomes, 21 although the utility of subclavian stenting in the absence of surgical decompression has been disappointing. 22 The duration of anticoagulation prior to surgery has also been debated, and some have even proposed withholding surgery for patients who are asymptomatic on warfarin after initial thrombolysis.…”

A Case of Idiopathic Upper Extremitiy Deep Vein Thrombosis

“…6 After surgery, venography can assess residual stricture, which should be treated with balloon venoplasty; if this fails, vein stenting can be considered. Long-term patency has been documented with this multimodal approach [23,27,35,36]. Surgical thrombectomy restores venous patency but is invasive, carries the risk of general anesthesia, and may be complicated by pneumothorax and brachial plexus damage.…”

“…As few as one half to as many as three fourths of these patients may develop this long-term complication [22,40,41]. Multimodal therapy that includes thrombolysis, will prevent these symptoms in the majority of patients [22,35,36,40]. Those with primary UEDVT are usually young and healthy, more active, live longer, and are not troubled by other chronic medical conditions.…”