Vascular and Thoracic Surgery, University Hospital, Angers, France.
Vascular and Thoracic Surgery, University Hospital, Angers, France.
Ann Vasc Surg. 2023 Oct;96:328-334. doi: 10.1016/j.avsg.2023.03.014. Epub 2023 Apr 5.
Paget-Schroetter syndrome (PSS) or effort-induced thrombosis is an acute (<14 days) venous thrombosis of the axillosubclavian vein. Early catheter-directed thrombolysis (CDT) is required to improve patency rate and avoid postthrombotic syndrome. This study aimed to report the management of PSS in our center across 10 years and compare it to the established guidelines.
Some of the selected patients were treated with CDT if the diagnosis of acute vein thrombosis was established 6 weeks after the appearance of the first symptoms and if a vascular surgeon was involved in the care and management of the patient. Patients underwent first rib removal 6 weeks after the CDT. Some patients with primary upper limb venous thrombosis were not immediately referred to a vascular surgeon after the initial diagnosis. They were instead discharged home with the prescription of oral anticoagulation therapy (OAT) alone for at least 3 months.
Between 2010 and 2020, 426 first rib removal procedures were performed for 338 patients with thoracic outlet syndrome (TOS) at our center. Among them, 18 (4.2%) patients with PSS were identified. 5 (27.8%) patients underwent CDT. The median duration between first symptoms and thrombolysis was 10 days (range, 1-32). Thirteen (72.2%) patients were discharged home with OAT alone and referred to a vascular surgeon with a median time of 365 days (range, 8-6,422) for TOS diagnosis. Postthrombotic syndrome was noticed in 5 (38%) patients in the OAT group and 1 (20%) patient in the CDT group.
Despite the guidelines being in favor of early CDT in PSS, most patients are discharged home with OAT alone. The study findings demonstrate that better information about this specific complication must be provided to the concerned practitioners who are likely to encounter such patients.
佩吉特-施罗氏病（Paget-Schroetter 综合征，PSS）或运动诱发血栓形成是一种急性（<14 天）腋-锁骨下静脉血栓形成。为了提高通畅率并避免血栓后综合征，需要早期进行导管定向溶栓（CDT）。本研究旨在报告我们中心在 10 年内对 PSS 的治疗方法，并与既定指南进行比较。
如果在首次出现症状后 6 周内确诊为急性静脉血栓形成，且血管外科医生参与患者的护理和管理，则选择部分患者进行 CDT。在 CDT 后 6 周，患者进行第一肋骨切除术。一些原发性上肢静脉血栓形成的患者在最初诊断后并未立即转介给血管外科医生，而是仅在家中服用口服抗凝治疗（OAT）至少 3 个月。
在 2010 年至 2020 年期间，我们中心对 338 例胸廓出口综合征（TOS）患者进行了 426 次第一肋骨切除术，其中 18 例（4.2%）患者被诊断为 PSS。其中 5 例（27.8%）患者接受了 CDT。首次症状与溶栓之间的中位时间为 10 天（范围，1-32 天）。13 例（72.2%）患者单独接受 OAT 治疗出院，并在中位时间 365 天（范围，8-6422 天）后转介给血管外科医生诊断 TOS。OAT 组中有 5 例（38%）患者出现血栓后综合征，CDT 组中有 1 例（20%）患者出现血栓后综合征。
尽管指南支持 PSS 早期进行 CDT，但大多数患者仍单独接受 OAT 治疗。本研究结果表明，必须向可能遇到此类患者的相关医生提供有关这种特定并发症的更好信息。
