Sr. Sheeran et al., LOCAL THROMBOLYTIC THERAPY AS PART OF A MULTIDISCIPLINARY APPROACH TOACUTE AXILLOSUBCLAVIAN VEIN-THROMBOSIS (PAGET-SCHROETTER SYNDROME), Journal of vascular and interventional radiology, 8(2), 1997, pp. 253-260
PURPOSE: To evaluate the efficacy of thrombolytic therapy in the treat
ment 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 axillosubclavi
an 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 w
ere treated with urokinase only (14 of 20) or urokinase combined with
percutaneous transluminal angioplasty (PTA) (six of 20), Nine of the 1
4 treatments with urokinase only (64%) resulted in complete lysis of t
hrombus, 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 t
herapy (urokinase or urokinase and PTA) alone (n = 4), or in combinati
on 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 th
e axillosubclavian vein and may be helpful in establishing a symptom-f
ree result in patients with Paget-Schroetter syndrome, Rib resection a
nd repeated thrombolytic therapy are frequently necessary to complete
treatment.