A Multidisciplinary Approach to the Treatment of Paget-Schroetter Syndrome

To assess the results of thrombolytic therapy and surgical decompression of the thoracic outlet in the management of spontaneous axillary vein thrombosis (AVT), the records of 38 patients at New York University Medical Center (NYUMC) with AVT were reviewed.Excluded from this report were 20 patients who had AVT secondary to an underlying medical condition, a subclavian catheter, or a failed dialysis access graft.Of the 18 remaining patients with no underlying medical condition, all were found to have effort-related axillo-subclavian thrombosis, Paget-Schroetter syndrome.Urokinase was used for thrombolysis in 17 of the 18 patients, (94.4%) with complete lysis in 14 (82.4%).The remaining patient received anticoagulation only following a favorable response to an initial heparin infusion.Of the patients achieving complete thrombolysis, all but one received urokinase within 8 days of the onset of symptoms.Clot lysis revealed axillary vein compression secondary to a thoracic outlet syndrome in 11 patients, and these underwent staged transaxillary thoracic outlet decompression by first rib resection.All 17 patients have been followed for a mean of 21 months, and none receiving lytic therapy have reoccluded.Review of these data confirms earlier reports showing that with early diagnosis, thrombolysis and, if indicated, thoracic outlet decompression, patients with spontaneous AVT can expect excellent clinical results with a good long-term prognosis.(Ann Vasc Surg 1997;ll: 149-1 54.)Paget-Schroetter syndrome, synonymous with spontaneous or effort-induced thrombosis of the axillarysubclavian vein, is a term that was first used in Hughs' renown 1949 review of 320 patients.'Though axillosubclavian thrombosis represents only 1 % -2 % of all venous thrombosis,2 its frequency of diagnosis has increased over the past several yearsa3 It is speculated that this is in part due to the improvement of ultrasonography which has From the Department of Surgery, Division of Surgery