9. PAGET-SCHROETTER SYNDROME: WHAT IS THE BEST MANAGEMENT
Harold C. Urschel Jr.* and Maruf A. Razzuk*
Baylor University Medical Center and UTSW Medical School
Dallas, Texas, USA
OBJECTIVE
The evaluation of 280 extremities in 242 patients with Paget-Schroetter (effort thrombosis of the axillary-subclavian vein) over 30 years provides the basis for optimal management determination.
METHODS AND RESULTS
Methods & Results: Group I (35 extremities) was initially treated with anticoagulants only. Twenty-one (21) developed recurrent symptoms after returning to work, requiring transaxillary resection of the first rib. Thrombectomy was necessary in eight (8). Group II (36 extremities) was treated with thrombolytic agents initially, with 20 requiring subsequent rib resection after returning to work. Thrombectomy was necessary only in four (4). Of the most recent 209 extremities (Group III), excellent results accrued using thrombolysis plus prompt first rib resection for those evaluated during the first month after occlusion (174). The results were only fair for those seen later than one month (35).
CONCLUSION
(1) An early diagnosis, (less than one month) (2) expeditious thrombolytic therapy, and (3) prompt first rib resection are critical for the best results.
