Local thrombolytic therapy as part of a multidisciplinary approach to acute axillosubclavian vein thrombosis (Paget-Schroetter syndrome).

PURPOSE

To evaluate the efficacy of thrombolytic therapy in the treatment of acute axillosubclavian vein thrombosis in patients with Paget-Schroetter syndrome.

MATERIALS AND METHODS

A 4.5-year, retrospective study of all patients with "effort" thrombosis of the axillosubclavian vein was performed.

RESULTS

Six men and eight women (age range, 18-56 years; mean, 34 years) presented with acute axillosubclavian vein thrombosis. Twenty thrombotic events occurred in the 14 patients and were treated with urokinase only (14 of 20) or urokinase combined with percutaneous transluminal angioplasty (PTA) (six of 20), Nine of the 14 treatments with urokinase only (64%) resulted in complete lysis of thrombus, whereas four treatments (29%) resulted in restoration of flow with some residual stenosis, yielding an immediate patency rate of 93%. Eight of the 14 patients remained asymptomatic after thrombolytic therapy (urokinase or urokinase and PTA) alone (n = 4), or in combination with a first rib resection (n = 4) at a mean follow-up of 24 months (range, 1-36 months).

CONCLUSIONS

Thrombolytic therapy appears to be a safe and efficacious method of establishing immediate patency of the axillosubclavian vein and may be helpful in establishing a symptom-free result in patients with Paget-Schroetter syndrome. Rib resection and repeated thrombolytic therapy are frequently necessary to complete treatment.