Original article: general thoracic
Paget-Schroetter syndrome therapy: failure of intravenous stents

Presented at the Forty-ninth Annual Meeting of the Southern Thoracic Surgical Association, Miami Beach, FL, Nov 7–9, 2002.
https://doi.org/10.1016/S0003-4975(03)00116-4Get rights and content

Abstract

Background

The purpose of this study is to show that intravenous stents (IS) are contraindicated in patients with thrombosis of the axillary-subclavian vein (Paget-Schroetter syndrome).

Methods

Twenty-two patients had IS placed after balloon dilatation of the venous compression in the thoracic outlet. Each of the patients receiving IS had the diagnosis made less than 6 weeks after vein occlusion, previous thrombolytic therapy, and poststent anticoagulants. (All were performed in outside hospitals. In no case was surgical decompression of the “externally constricted venous tunnel” performed.) The 22 patients receiving IS were compared with a similar group of 384 patients seen less than 6 weeks after thrombosis who were treated with “optimal therapy,” ie, thrombolysis and prompt transaxillary resection of the first rib with venous tunnel decompression.

Results

All 22 patients with IS reoccluded their axillary-subclavian vein from 1 day to 6 weeks after insertion. All were retreated with thrombolytic therapy and first rib resection. Ten remained patent and 7 remained occluded but developed adequate collateral circulation. All 17 were asymptomatic. Five remained occluded with minimal collateral circulation. Attempts were made to reopen them a third time. All 5 are receiving long-term anticoagulants. In contrast the 384 patients managed with optimal therapy were significantly improved without retreatment or anticoagulants.

Conclusions

From our study, there is no indication for use of IS in patients with Paget-Schroetter syndrome; in fact, from our experience it is contraindicated when compared with the optimal therapy group. Other authors corroborate this conclusion in recent review articles.

Section snippets

Patients

Twenty-two patients with PSS diagnosis, less than 6 weeks from initial thrombosis, received thrombolytics, venous balloon angioplasty, and intravenous stent placement. These were seen during a period of 8 years. There were 12 men and 10 women ranging in age from 17 to 42 years (mean, 29 years). All patients had stents placed in outside hospitals. There was no standardized indication for stent implantation, because the patients were referred from a number of different physicians and hospitals

Results

All 22 of the stent patients had thrombosis of the venous stents within 6 weeks of placement and were referred to our hospital. The 22 patients were retreated with the rethrombolysis protocol followed promptly by surgical decompression of the vein. Ten extremities were reopened and 12 remained occluded. Mean follow-up of 3.5 years (range, 1 to 8 years) showed 10 patients had patent veins. Of the other 12 patients with occluded veins, 7 developed good collateral circulation and were

Comment

Historically, Sir James Paget [17] in 1875 in London and Von-Schroetter [18] in 1884 in Vienna described this syndrome of thrombosis of the axillary-subclavian vein, which bears their names. The word “effort” [19] was added to thrombosis because of the frequent association with exertion superimposed on anatomic 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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