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Venous Thoracic Outlet Compression and the Paget-Schroetter Syndrome: A Review and Recommendations for Management

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Abstract

Paget Schroetter syndrome, or effort thrombosis of the axillosubclavian venous system, is distinct from other forms of upper limb deep vein thrombosis. It occurs in younger patients and often is secondary to competitive sport, music, or strenuous occupation. If untreated, there is a higher incidence of disabling venous hypertension than was previously appreciated. Anticoagulation alone or in combination with thrombolysis leads to a high rate of rethrombosis. We have established a multidisciplinary protocol over 15 years, based on careful patient selection and a combination of lysis, decompressive surgery, and postoperative percutaneous venoplasty. During the past 10 years, a total of 232 decompression procedures have been performed. This article reviews the literature and presents the Exeter Protocol along with practical recommendations for management.

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References

  1. Spencer FA, Emery C, Lessard D, Goldberg RJ (2008) Upper extremity deep vein thrombosis: a community-based perspective. J Vasc Surg 47(1):240–241

    Article  Google Scholar 

  2. Elman EE, Kahn SR (2006) The post-thrombotic syndrome after upper extremity deep venous thrombosis in adults: a systematic review. Thromb Res 117(6):609–614

    Article  PubMed  CAS  Google Scholar 

  3. Donayre CE, White GH, Mehringer SM, Wilson SE (1986) Pathogenesis determines late morbidity of axillosubclavian vein thrombosis. Am J Surg 152(2):179–184

    Article  PubMed  CAS  Google Scholar 

  4. Kahn SR, Elman EA, Bornais C, Blostein M, Wells PS (2005) Post-thrombotic syndrome, functional disability and quality of life after upper extremity deep venous thrombosis in adults. Thromb Haemost 93(3):499–502

    PubMed  CAS  Google Scholar 

  5. Persson LM, Arnhjort T, Lärfars G, Rosfors S (2006) Hemodynamic and morphologic evaluation of sequelae of primary upper extremity deep venous thromboses treated with anticoagulation. J Vasc Surg 43(6):1230–1235

    Article  PubMed  Google Scholar 

  6. Bliss S, Weinberger S, Meier M, Saint S (2002) The unusual suspect. N Engl J Med 347(23):1876–1881

    Article  PubMed  Google Scholar 

  7. Buller HR, Agnelli G, Hull RD, Hyers TM, Prins MH, Raskob GE (2004) Antithrombotic therapy for venous thromboembolic disease: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 126:401S–428S

    Article  PubMed  CAS  Google Scholar 

  8. Sajid MS, Ahmed N, Desai M, Baker D, Hamilton G (2007) Upper limb deep vein thrombosis: a literature review to streamline the protocol for management. Acta Haematol 118:10–18

    Article  PubMed  Google Scholar 

  9. Lee JT, Karwowski JK, Harris EJ, Haukoos JS, Olcott C (2006) Long-term thrombotic recurrence after nonoperative management of Paget-Schroetter syndrome. J Vasc Surg 43(6):1236–1243

    Article  PubMed  Google Scholar 

  10. Urschel HC, Patel AN (2003) Paget-Schroetter syndrome therapy: failure of intravenous stents. Ann Thorac Surg 75(6):1693–1696 discussion 1696

    Article  PubMed  Google Scholar 

  11. Urschel HC, Patel AN (2008) Surgery remains the most effective treatment for Paget-Schroetter syndrome: 50 years’ experience. Ann Thorac Surg 86(1):254–260 discussion 260

    Article  PubMed  Google Scholar 

  12. Machleder HI (1993) Evaluation of a new treatment strategy for Paget-Schroetter syndrome: spontaneous thrombosis of the axillary-subclavian vein. J Vasc Surg 17(2):305–317

    Article  PubMed  CAS  Google Scholar 

  13. Molina JE, Hunter DW, Dietz CA (2007) Paget-Schroetter syndrome treated with thrombolytics and immediate surgery. J Vasc Surg 45(2):328–334

    Article  PubMed  Google Scholar 

  14. Melby SJ, Vedantham S, Narra VR, Paletta GA, Khoo-Summers L, Driskill M et al (2008) Comprehensive surgical management of the competitive athlete with effort thrombosis of the subclavian vein (Paget-Schroetter syndrome). J Vasc Surg 47:809–820

    Article  PubMed  Google Scholar 

  15. Schneider DM, Dimuzio PJ, Martin LD, Gordon RL, Wilson MW, Laberge JM et al (2004) Combination treatment of venous thoracic outlet syndrome: open surgical decompression and intraoperative angioplasty. J Vasc Surg 40:599–603

    Article  PubMed  Google Scholar 

  16. de León RA, Chang DC, Hassoun HT, Black JH, Roseborough GS, Perler BA et al (2009) Multiple treatment algorithms for successful outcomes in venous thoracic outlet syndrome. Surgery 145(5):500–507

    Article  PubMed  Google Scholar 

  17. Caparrelli DJ, Freischlag J (2008) A unified approach to axillosubclavian venous thrombosis in a single hospital admission. Semin Vasc Surg 18(3):153–157

    Article  Google Scholar 

  18. Doyle A, Wolford HY, Davies MG, Adams JT, Singh MJ, Saad WE et al (2007) Management of effort thrombosis of the subclavian vein: today’s treatment. Ann Vasc Surg 21(6):723–729

    Article  PubMed  Google Scholar 

  19. Lee JT, Karwowski JK, Harris EJ, Haukoos JS, Olcott J (2006) Long-term thrombotic recurrence after nonoperative management of Paget-Schroetter syndrome. J Vasc Surg 43:1236–1243

    Article  PubMed  Google Scholar 

  20. Lokanathan R, Salvian AJ, Chen JC, Morris C, Taylor DC, Hsiang YN (2001) Outcome after thrombolysis and selective thoracic outlet decompression for primary axillary vein thrombosis. J Vasc Surg 33(4):783–788

    Article  PubMed  CAS  Google Scholar 

  21. Angle N, Gelabert HA, Farooq MM, Ahn SS, Caswell DR, Freischlag JA et al (2001) Safety and efficacy of early surgical decompression of the thoracic outlet for Paget-Schroetter syndrome. Ann Vasc Surg 15(1):37–42

    Article  PubMed  CAS  Google Scholar 

  22. Thompson JF (2001) Transaxillary first rib resection. In: Greenhalgh RM (ed) Vascular and endovascular surgical techniques. WB Saunders, London, pp 279–282

    Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Exeter Vascular Service and Peninsula College of Medicine and Dentistry, The Royal Devon and Exeter Hospital and Peninsula Medical and Dental School, Barrack Road, Exeter, Devon, EX2 5DW, UK

    J. F. Thompson & R. J. Winterborn

  2. Department of Interventional Radiology, Exeter Vascular Service and Peninsula College of Medicine and Dentistry, The Royal Devon and Exeter Hospital and Peninsula Medical and Dental School, Barrack Road, Exeter, Devon, EX2 5DW, UK

    S. Bays, H. White, D. C. Kinsella & A. F. Watkinson

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  1. J. F. Thompson
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  2. R. J. Winterborn
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  3. S. Bays
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  4. H. White
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  5. D. C. Kinsella
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  6. A. F. Watkinson
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Correspondence to J. F. Thompson.

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Thompson, J.F., Winterborn, R.J., Bays, S. et al. Venous Thoracic Outlet Compression and the Paget-Schroetter Syndrome: A Review and Recommendations for Management. Cardiovasc Intervent Radiol 34, 903–910 (2011). https://doi.org/10.1007/s00270-011-0148-4

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