Akoluk Arda, Douedi Steven, Dattadeen Jaraad, Patel Ishan, Mushtaq Arman, Levitt Michael, Asif Arif, Hossain Mohammad
Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA.
J Med Cases. 2020 Jan;11(1):22-25. doi: 10.14740/jmc3416. Epub 2020 Jan 31.
Paget-Schroetter syndrome (PSS) is a primary upper extremity deep vein thrombosis (DVT) that occurs with no significant risk factors, mostly in a young and healthy patient. Treatment of this disease is discussed heavily in the literature and the optimal treatment method is still being debated. Here, we present a patient with PSS treated with balloon angioplasty, thrombolysis and treatment with an oral thrombin inhibitor (apixaban) who developed recurrence of PSS. A 38-year-old white male with no past medical history, presented to an urgent care center with sudden onset axillary pain and an axillary lump that was treated with outpatient antibiotics. Extensive deep venous thrombosis was diagnosed with computed tomography (CT) and ultrasound. He underwent percutaneous pharmacomechanical thrombectomy. Postprocedural angiogram showed significant improvement in the caliber of the axillary and subclavian veins where they crossed the first rib. He was discharged on apixaban and underwent removal of his first rib 1 month later. He returned 3 weeks later with recurrence of right arm pain and swelling. Repeat ultrasound showed thrombus in the right arm and venogram confirmed 80% stenosis at the subclavian vein as it enters the innominate vein. He was again treated with placement of a thrombolytic catheter and overnight thrombolysis of the central venous circulation on the right-side upper extremity balloon angioplasty of the subclavian vein, axillary vein, and basilic vein. He is disease-free for 6 months. Recurrence of PSS after surgical removal of rib, thrombectomy, thrombolysis while using apixaban is very rare. This is the first case to our knowledge presented with recurrent PSS treated with apixaban, early rib resection, balloon angioplasty and thrombectomy.
佩吉特-施罗特综合征（PSS）是一种原发性上肢深静脉血栓形成（DVT），发生时无明显危险因素，多见于年轻健康患者。文献中对该疾病的治疗进行了大量讨论，最佳治疗方法仍存在争议。在此，我们报告一例接受球囊血管成形术、溶栓治疗及口服凝血酶抑制剂（阿哌沙班）治疗后复发的PSS患者。一名38岁无既往病史的白人男性因突发腋窝疼痛和腋窝肿块就诊于一家紧急护理中心，接受了门诊抗生素治疗。通过计算机断层扫描（CT）和超声诊断为广泛的深静脉血栓形成。他接受了经皮药物机械性血栓切除术。术后血管造影显示腋静脉和锁骨下静脉在穿过第一肋处的管径有显著改善。他出院时服用阿哌沙班，并在1个月后接受了第一肋切除术。3周后他因右臂疼痛和肿胀复发再次就诊。重复超声显示右臂有血栓，静脉造影证实锁骨下静脉进入无名静脉处有80%的狭窄。他再次接受了溶栓导管置入治疗，并对右侧上肢中央静脉循环进行了过夜溶栓，同时对锁骨下静脉、腋静脉和贵要静脉进行了球囊血管成形术。他已无病6个月。在使用阿哌沙班的情况下，手术切除肋骨、血栓切除术、溶栓治疗后PSS复发非常罕见。据我们所知，这是首例使用阿哌沙班、早期肋骨切除、球囊血管成形术和血栓切除术治疗复发性PSS的病例。
