Evaluation of a new treatment strategy for Paget-Schroetter syndrome: spontaneous thrombosis of the axillary-subclavian vein.

PURPOSE: The purpose of this study was to evaluate the efficacy of a staged, multimodal algorithm of therapy for durable correction of Paget-Schroetter syndrome.
METHODS: Fifty consecutive patients were entered into a sequential treatment program for spontaneous axillary-subclavian vein thrombosis. Forty-three had initial thrombolytic or anticoagulant treatment followed by longer-term warfarin sodium therapy. Thirty-six (72%) underwent surgical correction of the underlying structural abnormality, and nine patients had postoperative balloon angioplasty.
RESULTS: At the time of final evaluation, 93% of patients with a patent vein and 64% of those with an occluded vein were essentially free of symptoms. After surgical correction there were no episodes of recurrent thrombosis in a mean follow-up period of 3.1 years. Urokinase was the most effective pharmacologic agent for clot lysis (p = 0.003), and restoration of initial patency was the most significant factor in establishing final venous patency determined venographically (p = 0.0003).
CONCLUSIONS: It was concluded that a staged, multimodal approach to the Paget-Schroetter syndrome can effectively restore venous patency, reduce rethrombosis, and return normal function. The most effective sequence included transcatheter thrombolytic therapy, 3 months of anticoagulation therapy with warfarin sodium, and transaxillary first rib resection and decompression, followed by balloon angioplasty in cases of residual stricture.