Non-Operative Management of Paget-Schroetter Syndrome: A Single-Center Experience.

Abstract

OBJECTIVE:

The preponderance of existing literature for the treatment of Paget-Schroetter syndrome (PSS) advocates clot lysis followed by thoracic outlet decompression (TOD). We postulate that long-term anticoagulation has equal outcomes to more invasive and costly surgical intervention, and review our experience with non-operative management of PSS.

METHODS:

A retrospective review was conducted, examining patients between 1994-2014. Forty patients were identified with PSS, and 27 of these patients had sufficient follow-up for this analysis. Charts were reviewed for details of clinical presentation, disease course, interventions, duration of oral anticoagulation, ultrasound reports, and symptoms at long-term follow-up.

RESULTS:

With a mean follow-up of 54.3 months, 23/27 patients (85%) were asymptomatic after non-operative therapy. In this cohort, 16/27 patients (59%) underwent catheter-directed thrombolysis. Average treatment course with oral anticoagulation was 8.6 months. Four patients (15%) remained symptomatic at follow-up. Two patients (7%) underwent thoracic outlet decompression at another institution, with good results. At least partial recanalization of vessels was documented in 25/27 patients (93%), although recanalization did not correlate with symptoms at long-term follow-up.

CONCLUSIONS:

Based upon equivalent functional results, non-operative management appears to offer similar outcomes for some patients with PSS. We propose a patient-tailored approach to the treatment of PSS, in which patients presenting acutely undergo catheter-directed thrombolysis, followed by a 6-12 month course of oral anticoagulation. Persistent symptoms, recurrent disease, lengthy duration of symptoms prior to diagnosis, and identifiable structural abnormalities may be factors predictive of poor outcomes after non-operative intervention.

• Authors: Selena G Goss, Sean D Alcantara, George J Todd, John C Lantis 2nd
• Journal: The Journal of invasive cardiology (J Invasive Cardiol) Vol. 27 Issue 9 Pg. 423-8 (Sep 2015) ISSN: 1557-2501 [Electronic] United States
• PMID: 26332877 (Publication Type: Journal Article)

Chemical References

• Anticoagulants

Topics

• Administration, Oral
• Adult
• Anticoagulants (administration & dosage, adverse effects)
• Conservative Treatment (adverse effects, economics, methods, statistics & numerical data)
• Female
• Humans
• Long Term Adverse Effects (diagnosis, etiology, physiopathology)
• Male
• Outcome and Process Assessment, Health Care
• Patient Selection
• Retrospective Studies
• Risk Adjustment
• Symptom Assessment (methods, statistics & numerical data)
• Thrombolytic Therapy (adverse effects, economics, methods)
• United States
• Upper Extremity Deep Vein Thrombosis (diagnosis, etiology, physiopathology, therapy)