Ten-year Experience of Surgical Management of Paget-Schroetter Syndrome

Abstract

Paget-Schroetter syndrome (PSS) or effort-induced thrombosis, is an acute (< 14 days) venous thrombosis of the axillosubclavian vein. Early catheter-directed thrombolysis is required, to improve patency rate and avoid post thrombotic syndrome. This study aimed to report the management of Paget-Schroetter syndrome in our center across 10 years and to compare it to the established guidelines. Some of the selected patients were treated with catheter-directed thrombolysis (CDT) if the diagnosis of acute vein thrombosis was established 6 weeks after the appearance of the first symptoms and if a vascular surgeon was involved in the care and management of the patient. Patients underwent first rib removal 6 weeks after the CDT. Some patients with primary upper-limb venous thrombosis were not immediately referred to a vascular surgeon after the initial diagnosis. They were instead discharged home with the prescription of oral anticoagulation therapy (OAT) alone for at least 3 months. Between 2010 and 2020, 426 first rib removal procedures were performed for 338 patients with TOS at our center. Among them, eighteen (4.2%) patients with PSS were identified. Five (27.8%) patients underwent catheter directed thrombolysis. Median duration between first symptoms and thrombolysis was 10 days (range 1 to 32). Thirteen (72.2%) patients were discharged home with oral anticoagulation therapy alone and referred to a vascular surgeon with a median time of 365 days (range 8 to 6422) for thoracic outlet syndrome diagnosis. Post-thrombotic syndrome was noticed in 5 (38%) patients in the OAT group and 1 (20%) patient in the CDT group. Despite the guidelines being in favor of early CDT in Paget-Schroetter syndrome, most patients are discharged home o, oral anticoagulation therapy alone. The study findings demonstrate that better information about this specific complication must be provided to the concerned practitioners who are likely to encounter such patients.