Impact of Venous Collaterals on Clinical Outcomes in Paget-Schroetter Syndrome.

Abstract

PURPOSE:

To characterize the degree of venous collateralization before and after endovascular therapy and determine the effect of collateralization on success of thrombolysis and rate of repeat intervention in patients with Paget-Schroetter syndrome.

MATERIALS AND METHODS:

A single-center retrospective study of 37 extremities in 36 patients (mean age, 32.64 y; range, 15-72 y; 24 men) with PSS treated with endovascular therapy from 2007 through 2017 was conducted. Venograms at presentation, after lysis, postoperatively, and at each repeat intervention were graded for venous stenosis, thrombus burden, and collateralization on a 5-point scale. Collateralization was classified as high-grade (9 extremities) or low-grade (28 extremities) based on grading of the venograms at presentation.

RESULTS:

Primary technical success rate for endovascular treatment was 100%. Eighty-six percent of patients (32 of 37) underwent thrombolysis, 91% (34 of 37) underwent mechanical thrombectomy, and 83% (30 of 37) underwent balloon angioplasty. Overall primary patency rate was 50% at 12 months. The repeat intervention rate within 12 months was significantly higher for extremities with high- vs low-grade collateralization (89% vs 43%; P = .016). There was a significant decrease in the median grade of collateral severity after initial intervention (2 vs 1; P = .044) and 1 day postoperatively (2 vs 1; P = .040) vs the venogram at presentation.

CONCLUSIONS:

Severity of venous collateralization on the venogram at presentation of patients with PSS does not appear to affect success of endovascular therapy but may predict long-term patency of affected extremities. Patients in this cohort with severe collateralization on presentation were more likely to need repeat intervention.

• Authors: Daniel Rohan Phadke, Daniel P Sheeran, Luke R Wilkins, John A Kern, Margaret C Tracci, John F Angle
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 30 Issue 4 Pg. 572-577 (Apr 2019) ISSN: 1535-7732 [Electronic] United States
• PMID: 30910179 (Publication Type: Journal Article)
• Copyright: Copyright © 2018 SIR. Published by Elsevier Inc. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Angioplasty, Balloon (adverse effects)
• Collateral Circulation
• Female
• Humans
• Male
• Middle Aged
• Regional Blood Flow
• Retreatment
• Risk Factors
• Thrombectomy (adverse effects)
• Thrombolytic Therapy (adverse effects)
• Time Factors
• Treatment Outcome
• Upper Extremity (blood supply)
• Upper Extremity Deep Vein Thrombosis (diagnostic imaging, physiopathology, therapy)
• Vascular Patency
• Veins (diagnostic imaging, physiopathology)
• Young Adult