Original articles: General thoracic
Paget-Schroetter syndrome: what is the best management?

Presented at the Forty-sixth Annual Meeting of the Southern Thoracic Surgical Association, San Juan, Puerto Rico, Nov 4–6, 1999.
https://doi.org/10.1016/S0003-4975(00)01151-6Get rights and content

Abstract

Background. The evaluation of 312 extremities in 294 patients with Paget-Schroetter syndrome (effort thrombosis of the axillary-subclavian vein) over 30 years provides the basis for optimal management determination.

Methods and Results. Group I (35 extremities) was initially treated with anticoagulants only. Twenty-one developed recurrent symptoms after returning to work, requiring transaxillary resection of the first rib. Thrombectomy was necessary in eight. Group II (36 extremities) was treated with thrombolytic agents initially, with 20 requiring subsequent rib resection after returning to work. Thrombectomy was necessary only in four. Of the most recent 241 extremities (group III), excellent results accrued using thrombolysis plus prompt first rib resection for those evaluated during the first month after occlusion (199). The results were only fair for those if seen later than 1 month (42).

Conclusions. An early diagnosis (less than 1 month), expeditious thrombolytic therapy, and prompt first rib resection are critical for the best results.

Section snippets

Material and methods

Clinical manifestations of “effort” thrombosis of the axillary subclavian vein in the acute and subacute phases were evaluated in 312 extremities of 294 patients, 18 being bilateral. (For the remainder of the discussion, the number of the extremities will be assessed rather than the number of patients.) There were 154 female and 140 male extremities, ranging in age from 16 to 51 years, with a mean of 32 years. Trauma was involved in 125 extremities. Two hundred one had unusual occupations that

Results

Results were evaluated as excellent, good, fair, or poor according to the criteria in Table 3and are summarized in Table 4. In group I, 10 extremities of the 35 showed substantial improvement with anticoagulation and evaluation therapy. In 25 extremities, symptoms either were not completely improved or recurred. The pain, swelling, and dysfunction usually occurred when the patient returned to the job that had produced the difficulty initially. Twenty-one of those required first rib resection,

Comment

Historically, Sir James Paget [2] in 1875 in London and Von-Schroetter [1] in 1884 in Vienna described this syndrome of thrombosis of the axillary-subclavian vein, which bears their names. The word “effort” [14] was added to thrombosis because of the frequent association with exertion superimposed on anatomical compressive elements in the thoracic outlet. Trauma, unusual occupations requiring repetitive muscular activity, as has been observed in professional athletes, linotype operators,

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