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Ann Thorac Surg 2000;69:1663-1668
© 2000 The Society of Thoracic Surgeons
a Division of Thoracic and Cardiovascular Surgery, The University of Texas Southwestern Medical School and Baylor University Medical Center, Dallas, Texas, USA
Address reprint requests to Dr Urschel, 3600 Gaston Ave, Suite 1201, Barnett Tower, LB 161, Dallas, TX 75246
e-mail: urschel1{at}airmail.net
Presented at the Forty-sixth Annual Meeting of the Southern Thoracic Surgical Association, San Juan, Puerto Rico, Nov 4–6, 1999.
Background. The evaluation of 312 extremities in 294 patients with Paget-Schroetter syndrome (effort thrombosis of the axillary-subclavian vein) over 30 years provides the basis for optimal management determination.
Methods and Results. Group I (35 extremities) was initially treated with anticoagulants only. Twenty-one developed recurrent symptoms after returning to work, requiring transaxillary resection of the first rib. Thrombectomy was necessary in eight. 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. Of the most recent 241 extremities (group III), excellent results accrued using thrombolysis plus prompt first rib resection for those evaluated during the first month after occlusion (199). The results were only fair for those if seen later than 1 month (42).
Conclusions. An early diagnosis (less than 1 month), expeditious thrombolytic therapy, and prompt first rib resection are critical for the best results.
Related Article
Ann. Thorac. Surg. 2000 69: 1668-1669.
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