Department of Vascular Surgery, Abdominal Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Vascular Surgery, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt.
Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.
J Vasc Surg Venous Lymphat Disord. 2018 Jan;6(1):75-82. doi: 10.1016/j.jvsv.2017.07.010. Epub 2017 Nov 9.
Young, active persons may suffer lifelong consequences of subclavian vein thrombosis, but the best treatment options remain unclear. On introduction of more active pharmacomechanical thrombus removal and thoracoscopic rib resection in our institution, we planned a diagnostic and treatment protocol and aimed to analyze the early, midterm, and intermediate-term results.
The study included 72 patients who were diagnosed with an upper limb deep venous thrombosis and underwent phlebography between 2006 and 2013. After the initial treatment, control phlebography was performed and a thoracoscopic first rib resection was considered. Postoperative balloon angioplasty was performed when appropriate, and 1-year follow-up phlebography was carried out.
After the initial thrombus removal, 60 patients were treated with thoracoscopic first rib resection and subsequent phlebography with or without balloon angioplasty. The median time from symptom to surgery was 124 days, and six (10%) patients had a reocclusion before surgery. Ten (16.7%) patients experienced complications, which were treated mainly with a chest tube (n = 3) or thoracoscopic re-exploration (n = 4). Three months after surgery, 98.3% (59/60) experienced an overall relief of symptoms. No recurrence of clinical thrombosis or residual compression due to incomplete rib resection was seen, and 96.6% (56/58) of the patients reported an overall improvement of symptoms at 13 months. Two patients (3.4%) were treated for chronic pain and had electroneuromyography-verified nerve plexus damage. In both cases, the pain was relieved in the long run.
A combination of early thrombus removal, thoracoscopic first rib resection, and postoperative venous balloon angioplasty seems to yield acceptable intermediate-term results after Paget-Schroetter thrombosis.
年轻、活跃的个体可能会因锁骨下静脉血栓形成而终身受到影响，但最佳治疗方案仍不明确。在我们机构引入更积极的溶栓联合胸腔镜下肋骨切除术后，我们制定了诊断和治疗方案，并旨在分析早期、中期和中期结果。
该研究纳入了 72 例上肢深静脉血栓形成患者，这些患者于 2006 年至 2013 年间接受了静脉造影检查。初始治疗后，进行了控制静脉造影检查，并考虑进行胸腔镜下第一肋骨切除术。如果合适，进行术后球囊血管成形术，并进行 1 年的静脉造影随访。
在初始血栓清除后，60 例患者接受了胸腔镜下第一肋骨切除术和随后的静脉造影检查，同时进行或不进行球囊血管成形术。从症状到手术的中位时间为 124 天，有 6 例（10%）患者在手术前发生再闭塞。10 例（16.7%）患者出现并发症，主要通过胸腔引流管（n=3）或胸腔镜再次探查（n=4）进行治疗。术后 3 个月，98.3%（59/60）的患者症状总体缓解。未发现临床血栓复发或因肋骨切除不完全导致的残留压迫，96.6%（56/58）的患者在 13 个月时报告症状总体改善。2 例患者（3.4%）因慢性疼痛接受治疗，并进行了神经肌电图证实的神经丛损伤。在这两种情况下，疼痛均在长期内得到缓解。
在 Paget-Schroetter 血栓形成后，早期血栓清除、胸腔镜下第一肋骨切除和术后静脉球囊血管成形术联合治疗似乎可获得可接受的中期结果。
