INITIAL EXPERIENCE WITH VENOUS STENTS IN EXERTIONAL AXILLARY-SUBCLAVIAN VEIN-THROMBOSIS

Purpose: Exertional thrombosis of the axillary and subclavian veins, a lso known as Paget-Schrotter syndrome, has been increasingly recognize d in recent gears as a cause of long-term morbidity. Recent aggressive approaches to treating Paget-Schrotter syndrome have suggested the as sociation of early failure with residual subclavian vein stenosis. As a result, the use of endoluminal stents has been proposed as an aid to venous percutaneous transluminal angioplasty for this disorder. Metho ds: This report outlines the therapy of II consecutive patients with P aget-Schrotter syndrome who were treated at our institution between Oc tober, 1992, and December, 1995. Stents were placed when percutaneous transluminal angioplasty was unsuccessful at achieving an adequate res idual lumen. Results: Stents were placed after initial thrombolysis in six patients and in late follow-up in two patients. Of the six patien ts who had stents placed at initial thrombolysis, first-rib resection was eventually performed in four. In two patients first-rib resection was not performed, and stent fracture occurred in both. Late patency w as achieved in the stents of six of the eight patients. Conclusions: T rials to evaluate stents as an adjunct to conventional therapy seem wa rranted. The use of stents alone without first-rib resection, however, appears to be associated with stent fracture.