LOCAL THROMBOLYTIC THERAPY AS PART OF A MULTIDISCIPLINARY APPROACH TOACUTE AXILLOSUBCLAVIAN VEIN-THROMBOSIS (PAGET-SCHROETTER SYNDROME)

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.