Treatment of Paget-Schroetter syndrome. A staged, multidisciplinary approach.

A comprehensive approach to management of Paget-Schroetter syndrome was developed and applied to 25 consecutive patients. We studied 14 men and 11 women with an average age of 29 years, 17 of whom were either competitive athletes or industrial workers with onset of symptoms related to physical stress. Venous compression or thrombosis at the thoracic outlet was demonstrated in all patients, with similar abnormalities in the contralateral vein visualized in 12 of 15 patients studied. Eight of 17 patients had evoked potential loss of the brachial plexus peak (N9), and 21 patients had stress compression of the subclavian artery. Osseous or musculotendinous abnormalities were documented in 18 patients. Excellent functional results were obtained when initial treatment with high-dose local thrombolytic agents (11 patients) was followed by anticoagulation. Transaxillary first rib resection (17 patients) and balloon angioplasty (3 patients) were used in selected patients with residual symptoms or venous compression.