Changing Strategies to Treat Venous Thrombotic Occlusions of the Upper and Lower Extremities Secondary to Compressive Phenomena

Abstract

Objectives:

We reviewed our strategies during the last decade for deep vein thrombosis (DVT) of the upper extremity due to thoracic outlet syndrome (TOS) andthe lower extremity.

Methods:

Between 1998 and 2011, we treated 31 patients with 18 subclavian DVTs and 13 iliac DVTs. Management included catheter-directed thrombolysis compared to mechanical thrombolysis (MT; post 2006). Prior to 2006, patients with TOS were treated with total excision of the first rib compared to excision of the anterior half of the rib. Patients were followed up with serial duplex ultrasounds.

Results:

There was no major morbidity and no mortality in these 31 patients. Three patients developed recurrent DVT but maintained patency after further treatment.

Conclusion:

Use of MT has led to shorter treatment duration and length of hospital stay. Limiting first rib resection to the anterior half of the rib shortened operative time. Patients requiring stents had excellent long-term patency rates.

Keywords

DVT venous thoracic outlet syndrome May-Thurner Paget-Schroetter syndrome

Get full access to this article

View all access options for this article.

References

Meissner

Gloviczki

Comerota

. Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2012;55(5):1449–1462.

Raju

Darcey

Neglén

. Unexpected major role for venous stenting in deep reflux disease. J Vasc Surg. 2010;51(2):401–408.

Mussa

Peden

Zhou

Lin

Lumsden

Bush

. Iliac vein stenting for chronic venous insufficiency. Tex Heart Inst J. 2007;34(1):60–66.

Delis

Bjarnason

Wennberg

Rooke

Gloviczki

. Successful iliac vein and inferior vena cava stenting ameliorates venous claudication and improves venous outflow, calf muscle pump function, and clinical status in post-thrombotic syndrome. Ann Surg. 2007;245(1):130–139.

Paget

. Clinical Lectures and Essays. London, UK: Longmans Green; 1875.

von Schroetter

Erkrankungen der gefasse. In: Nothnagel’s Handbuch. Vol 15; 1899:533–535.

Sharafuddin

Sun

Hoballah

. Endovascular management of venous thrombotic diseases of the upper torso and extremities. J Vasc Interv Radiol. 2002;13(10):975–990.

Schneider

Dimuzio

Martin

. Combination treatment of venous thoracic outlet syndrome: open surgical decompression and intraoperative angioplasty. J Vasc Surg. 2004;4(40):599–603.

Neglen

Raju

. Intravascular ultrasound scan evaluation of the obstructed vein. J Vasc Surg. 2002;35(4):694–700.

10.

Neglen

Berry

Raju

. Endovascular surgery in the treatment of chronic primary and post-thrombotic iliac vein obstruction. Eur J Vasc Endovasc Surg. 2000;20(6):560–571.

11.

Sanders

Haug

CE.

Thoracic Outlet Syndrome: A Common Sequelae of Neck Injuries. Philadelphia, PA: Lippincott Williams & Wilkins; 1991.

12.

Urschel

Jr . The transaxillary approach for treatment of thoracic outlet syndrome. Semin Thorac Cardiovasc Surg. 1996;8(2):214–220.

13.

Thompson

Petrinec

Toursarkissian

Surgical treatment of thoracic outlet compression syndromes. II. Supraclavicular exploration and vascular reconstruction. Ann Vasc Surg. 1997;11(4):442–451.

14.

Melby

Vedantham

Narra

. Comprehensive surgical management of the competitive athlete with effort thrombosis of the subclavian vein (Paget-Schroetter syndrome). J Vasc Surg. 2008;4(47):809–820.

15.

Landry

Liem

. Endovascular management of Paget-Schroetter syndrome. Vascular. 2007;15(5):290–296.

16.

Stone

Scali

Bjerk

. Aggressive treatment of idiopathic axillo-subclavian vein thrombosis provides excellent long-term function. J Vasc Surg. 2010;52(1):127–131.