Management Of Paget-Schroetter Syndrome Research Articles

Paget Schroetter Patients with Chronic Venous Occlusion Benefit from Surgical Decompression

Management of Paget Schroetter syndrome (PSS) with first rib resection (FRR) and venoplasty is successful in reestablishing subclavian vein (SCV) patency in most cases. However, in cases with chronic venous occlusion, SCV patency might not be achieved. Thus, the role for FRR has remained controversial in cases of chronic occlusion. Our goal was to determine whether FRR is beneficial for PSS patients with an occluded SCV.

The diagnosis and management of Paget-Schroetter syndrome (primary effort thrombosis) in the emergency department

The diagnosis and management of Paget-Schroetter syndrome (primary effort thrombosis) in the emergency department

Paget-Schroetter syndrome: A contemporary review of the controversies in management.

To assess the current evidence, controversies and technologies behind the various approaches and steps in the management of Paget-Schroetter syndrome. We performed a narrative review based on a literature search in Embase, Medline, Pubmed and Google Scholar through keyword searching related to upper extremity deep vein thrombosis, Paget-Schroetter syndrome and venous thoracic outlet syndrome. There is a paucity of high-quality evidence assessing the efficacy of contemporary approaches for the management of acute upper extremity deep vein thrombosis which, though promising, is largely limited to single institution case studies and small series. As a result, a formal systematic review could not be performed. Paget-Schroetter syndrome is a rare condition, whose management approaches are largely guided by the accumulated expertise and clinical experience of vascular specialists. In the absence of randomized controlled trials, current practice has been guided by retrospective reviews and experience. Modern approaches and protocols appear to remain distinct between health care facilities, but have common features including early clot lysis, surgical decompression with first rib resection, followed by adjunctive open or endovascular procedures. Further high-quality level 1 evidence and research are required in order to standardize treatment for this condition.

Surgery Remains the Most Effective Treatment for Paget-Schroetter Syndrome: 50 Years' Experience

Significant improvements were made in the diagnosis and management of Paget-Schroetter syndrome (thrombosis of the axillary-subclavian vein) secondary to thoracic outlet syndrome during the past 50 years. The diagnosis has often been extremely difficult. Multiple approaches both in diagnosis and therapy have been tried during the years. After recognizing that the underlying pathologic process resulted from an abnormal insertion of the costoclavicular ligament laterally on the first rib, along with hypertrophy of the scalenus anticus muscle, 506 of 626 extremities have been managed by thrombolytic therapy followed by prompt transaxillary resection of the first rib. These patients have been followed up from 1 to 32 years (average of 7.2 years +/- 1.0 standard deviation). Four hundred eighty-six patients (96%) improved. Because the pathophysiology is not well understood, many venograms suggest intraluminal disease rather than external compression. Therefore, attempts at opening the narrowed vein with intraarterial techniques do not work. Use of percutaneous venous angioplasty with stents have all occluded in our experience, making further management difficult. Venous bypass grafts fail because of low venous pressure. Recognition that an abnormal congenital lateral insertion of the costoclavicular ligament on the first rib causes venous occlusion in Paget-Schroetter syndrome has led to acute thrombolysis, followed by prompt first rib resection, as the ideal management.

Long-term thrombotic recurrence after nonoperative management of Paget-Schroetter syndrome

Long-term thrombotic recurrence after nonoperative management of Paget-Schroetter syndrome

Long-term thrombotic recurrence after nonoperative management of Paget-Schroetter syndrome

Long-term thrombotic recurrence after nonoperative management of Paget-Schroetter syndrome

Paget-Schroetter syndrome

Objective: To review current approaches to investigation and management of Paget-Schroetter syndrome (PSS). Methods: Relevant clinical studies and reports were searched for using MEDLINE and Embase databases and cross-referenced articles. Articles were extracted using keywords by the two authors independently. Principal findings: There is growing evidence of functional or positional anatomical defects, which lead to subtle intimal injury and a tendency for recurrence or poor outcome. Management of PSS remains controversial. Anticoagulation as a stand-alone treatment has lost favour. Active treatment with thrombolysis followed by consideration of thoracic decompression is recommended by most in the recent literature. Thrombolytic therapy appears to be a safe and efficacious method of establishing immediate patency of the axillary/subclavian vein. The timing and indications of decompression surgery are yet to be defined clearly. There are no randomized trials of treatment or management strategies in PSS. Conclusions: Treatment of PSS remains contentious. Most authors recommend active treatment with thrombolysis followed by thoracic decompression. Multicentre randomized trials are needed.

Safety and Efficacy of Early Surgical Decompression of the Thoracic Outlet for Paget-Schroetter Syndrome

The surgical treatment of Paget-Schroetter syndrome has evolved to include early thrombolytic therapy and an interval period of anticoagulation, followed by late surgical decompression of the thoracic outlet. More recently, we have developed an abbreviated course of therapy in which the thrombolytic therapy is followed by early surgical decompression during the same admission, then a period of anticoagulation. We compared early surgical decompression with the standard management protocol to determine safety and efficacy of the early treatment algorithm. Nine patients were treated with lysis and early operation. These were compared with the preceding nine consecutive patients treated with lysis and staged operation. Demographic data, risk factors, duration of thrombosis, lytic therapy, time to surgery, operative variables, and postoperative complications were analyzed. Our results showed that thrombolysis followed by early operation does not result in increased perioperative morbidity or mortality. Early surgical decompression of the thoracic outlet during the same admission as lysis is as safe and efficacious as the traditional (staged decompression) approach to Paget-Schroetter syndrome. Lysis followed by early surgical decompression should be considered a new standard of care in the management of Paget-Schroetter syndrome.