Local thrombolytic therapy as part of a multidisciplinary approach to acute axillosubclavian vein thrombosis (Paget-Schroetter syndrome)

Sean R. Sheeran, Michael J. Hallisey, Timothy P. Murphy, Robert S. Faberman, Stuart Sherman

Research output: Contribution to journalArticle

44 Scopus citations

Abstract

PURPOSE: To evaluate the efficacy of thrombolytic therapy in the treatment of acute axillosubclavian vein thrombosis in patients with Paget- Schroetter syndrome. MATERIALS AND METHODS: A 4.5-year, retrospective study of all patients with 'effort' thrombosis of the axillosubclavian vein was performed. RESULTS: Six men and eight women (age range, 18-56 years; mean, 34 years) presented with acute axillosubclavian vein thrombosis. Twenty thrombotic events occurred in the 14 patients and were treated with urokinase only (14 of 20) or urokinase combined with percutaneous transluminal angioplasty (PTA) (six of 20). Nine of the 14 treatments with urokinase only (64%) resulted in complete lysis of thrombus, whereas four treatments (29%) resulted in restoration of flow with some residual stenosis, yielding an immediate patency rate of 93%. Eight of the 14 patients remained asymptomatic after thrombolytic therapy (urokinase or urokinase and PTA) alone (n = 4), or in combination with a first rib resection (n = 4) at a mean follow-up of 24 months (range, 1-36 months). CONCLUSIONS: Thrombolytic therapy appears to be a safe and efficacious method of establishing immediate patency of the axillosubclavian vein and may be helpful in establishing a symptom-free result in patients with Paget-Schroetter syndrome. Rib resection and repeated thrombolytic therapy are frequently necessary to complete treatment.

Original languageEnglish (US)
Pages (from-to)253-260
Number of pages8
JournalJournal of Vascular and Interventional Radiology
Volume8
Issue number2
DOIs
StatePublished - Jan 1 1997
Externally publishedYes

Keywords

  • Thrombolysis
  • Thrombosis, venous
  • Urokinase
  • Veins, axillary
  • Veins, subclavian

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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