Tommy Y Cai1,2, Saissan Rajendran1,3, Prakash Saha1,4, Steven Dubenec1. 1. Department of Vascular Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. 2. School of Medicine, University of Sydney, Sydney, NSW, Australia. 3. Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia. 4. Academic Department of Vascular Surgery, St Thomas' Hospital, King's College London, London, UK.
Abstract
AIM: To assess the current evidence, controversies and technologies behind the various approaches and steps in the management of Paget-Schroetter syndrome. MATERIALS AND METHODS: We performed a narrative review based on a literature search in Embase, Medline, Pubmed and Google Scholar through keyword searching related to upper extremity deep vein thrombosis, Paget-Schroetter syndrome and venous thoracic outlet syndrome. RESULTS: There is a paucity of high-quality evidence assessing the efficacy of contemporary approaches for the management of acute upper extremity deep vein thrombosis which, though promising, is largely limited to single institution case studies and small series. As a result, a formal systematic review could not be performed. CONCLUSIONS: Paget-Schroetter syndrome is a rare condition, whose management approaches are largely guided by the accumulated expertise and clinical experience of vascular specialists. In the absence of randomized controlled trials, current practice has been guided by retrospective reviews and experience. Modern approaches and protocols appear to remain distinct between health care facilities, but have common features including early clot lysis, surgical decompression with first rib resection, followed by adjunctive open or endovascular procedures. Further high-quality level 1 evidence and research are required in order to standardize treatment for this condition.
AIM: To assess the current evidence, controversies and technologies behind the various approaches and steps in the management of Paget-Schroetter syndrome. MATERIALS AND METHODS: We performed a narrative review based on a literature search in Embase, Medline, Pubmed and Google Scholar through keyword searching related to upper extremity deep vein thrombosis, Paget-Schroetter syndrome and venous thoracic outlet syndrome. RESULTS: There is a paucity of high-quality evidence assessing the efficacy of contemporary approaches for the management of acute upper extremity deep vein thrombosis which, though promising, is largely limited to single institution case studies and small series. As a result, a formal systematic review could not be performed. CONCLUSIONS:Paget-Schroetter syndrome is a rare condition, whose management approaches are largely guided by the accumulated expertise and clinical experience of vascular specialists. In the absence of randomized controlled trials, current practice has been guided by retrospective reviews and experience. Modern approaches and protocols appear to remain distinct between health care facilities, but have common features including early clot lysis, surgical decompression with first rib resection, followed by adjunctive open or endovascular procedures. Further high-quality level 1 evidence and research are required in order to standardize treatment for this condition.
Entities:
Keywords:
Paget-Schrotter syndrome; Thoracic outlet; first rib resection; upper extremity deep vein thrombosis; venoplasty; venous stenting