Long-term results in patients treated with thrombolysis, thoracic inlet decompression, and subclavian vein stenting for Paget-Schroetter syndrome

Purpose: In an effort to minimize long-term disability related to effort th rombosis of the subclavian vein, selected patients were treated with thromb olysis, thoracic inlet decompression, percutaneous transluminal angioplasty (PTA), and subclavian vein stenting. We evaluated the long-term outcomes o f patients treated with this algorithm. Methods: Between 1994 and 2000, 23 patients were evaluated with effort thro mbosis of the subclavian vein. Thrombolysis was instituted on an average of 9.4 days (range, 1-30 days) after initial onset of symptoms. Average time to clot lysis was 34 hours (range, 12-72 hours). After immediate supraclavi cular thoracic inlet decompression, all patients underwent PTA. Fourteen pa tients with residual vein stenosis (>50%) after PTA underwent stenting of t he subclavian vein. Complications in this series included three wound hemat omas that required drainage in two patients and one subpleural hematoma tha t required thoracotomy for decompression. Results: All patients who underwent PTA are patent, with a mean follow-up o f 4 years (range, 2-6 years). In the veins treated with stents, 9 of 14 vei ns are patent, with a mean follow-up of 3.5 years (range, 1-6 years). Two v eins had early occlusions (2 days); two veins occluded at 1 year; and seven veins occluded at 3 years. Three of the patients (including those patients who experienced the early failed procedures) were later identified with fa ctor V Leiden. Early failures also had clot extending into the brachial vei n. Conclusion: Patients with short-segment venous strictures after successful lysis and thoracic outlet decompression may safely be treated with subclavi an venous stents and can expect long-term patency.