Document Detail


Long-term results in patients treated with thrombolysis, thoracic inlet decompression, and subclavian vein stenting for Paget-Schroetter syndrome.
MedLine Citation:
PMID:  11174819     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: In an effort to minimize long-term disability related to effort thrombosis of the subclavian vein, selected patients were treated with thrombolysis, thoracic inlet decompression, percutaneous transluminal angioplasty (PTA), and subclavian vein stenting. We evaluated the long-term outcomes of patients treated with this algorithm.
METHODS: Between 1994 and 2000, 23 patients were evaluated with effort thrombosis of the subclavian vein. Thrombolysis was instituted on an average of 9.4 days (range, 1-30 days) after initial onset of symptoms. Average time to clot lysis was 34 hours (range, 12-72 hours). After immediate supraclavicular thoracic inlet decompression, all patients underwent PTA. Fourteen patients with residual vein stenosis (>50%) after PTA underwent stenting of the subclavian vein. Complications in this series included three wound hematomas that required drainage in two patients and one subpleural hematoma that required thoracotomy for decompression.
RESULTS: All patients who underwent PTA are patent, with a mean follow-up of 4 years (range, 2-6 years). In the veins treated with stents, 9 of 14 veins are patent, with a mean follow-up of 3.5 years (range, 1-6 years). Two veins had early occlusions (2 days); two veins occluded at 1 year; and seven veins occluded at 3 years. Three of the patients (including those patients who experienced the early failed procedures) were later identified with factor V Leiden. Early failures also had clot extending into the brachial vein.
CONCLUSION: Patients with short-segment venous strictures after successful lysis and thoracic outlet decompression may safely be treated with subclavian venous stents and can expect long-term patency.
Authors:
P B Kreienberg; B B Chang; R C Darling; S P Roddy; P S Paty; W E Lloyd; D Cohen; B Stainken; D M Shah
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  33     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2001 Feb 
Date Detail:
Created Date:  2001-02-22     Completed Date:  2001-03-22     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S100-5     Citation Subset:  IM    
Affiliation:
Institute for Vascular Health and Disease, Albany Medical College, NY 12208, USA.
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MeSH Terms
Descriptor/Qualifier:
Activated Protein C Resistance / blood,  complications
Adolescent
Adult
Algorithms
Angioplasty, Balloon, Coronary / adverse effects,  instrumentation,  methods*
Clinical Protocols
Combined Modality Therapy
Decompression, Surgical / adverse effects,  methods*
Exercise*
Factor V / analysis
Female
Follow-Up Studies
Humans
Male
Middle Aged
Phlebography
Stents*
Subclavian Vein*
Syndrome
Thrombolytic Therapy / adverse effects,  methods*
Thrombosis / etiology,  radiography,  therapy*
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/factor V Leiden; 9001-24-5/Factor V

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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