A MULTIDISCIPLINARY APPROACH TO THE TREATMENT OF PAGET-SCHROETTER SYNDROME

To assess the results of thrombolytic therapy and surgical decompressi on of the thoracic outlet in the management of spontaneous axillary ve in thrombosis (AVT), the records of 38 patients at New York University Medical Center (NYUMC) with AVT were reviewed. Excluded from this rep ort were 20 patients who had AVT secondary to an underlying medical co ndition, a subclavian catheter, or a failed dialysis access graft. Of the 18 remaining patients with no underlying medical condition, all we re found to have effort-related axillo-subclavian thrombosis, Paget-Sc hroetter syndrome. Urokinase was used for thrombolysis in 17 of the 18 patients, (94.4%) with complete lysis in 14 (82.4%). The remaining pa tient received anticoagulation only following a favorable response to an initial heparin infusion. Of the patients achieving complete thromb olysis, all but one received urokinase within 8 days of the onset of s ymptoms. Clot lysis revealed axillary vein compression secondary to a thoracic outlet syndrome in II patients, and these underwent staged tr ansaxillary thoracic outlet decompression by first rib resection. All 17 patients have been followed for a mean of 21 months, and none recei ving lytic therapy have reoccluded. Review of these data confirms earl ier reports showing that with early diagnosis, thrombolysis and, if in dicated, thoracic outlet decompression, patients with spontaneous AVT can expect excellent clinical results with a good long-term prognosis.