Paget-Schroetter syndrome: what is the best management?

Life-threatening acute and chronic thromboembolic pulmonary hypertension and subclavian vein thrombosis

“…A multimodal therapeutic approach consisting of early thrombolysis (local or systemic) followed by systemic anticoagulation prior to surgical thoracic outlet decompression (first rib resection) has recently been shown to yield outcomes superior to more conservative therapy. 3,20 The use of subclavian angioplasty and stenting following surgical decompression may further improve outcomes, 21 although the utility of subclavian stenting in the absence of surgical decompression has been disappointing. 22 The duration of anticoagulation prior to surgery has also been debated, and some have even proposed withholding surgery for patients who are asymptomatic on warfarin after initial thrombolysis.…”

“…3 The treatment of chronic thromboembolic PH has improved over time. While thrombolysis is an effective therapy for acute pulmonary emboli, its utility decreases significantly if treatment is delayed more than 6 weeks, 3 and therefore is of limited use in patients with chronic thromboembolic disease. Currently, pulmonary thromboendarterectomy is the preferred therapy 17 and may be curative.…”

Upper Extremity Deep Vein Thrombosis (Paget –Von Schroetter Syndrome) - A Rare Case Report

“…Repetitive overhead arm movements or hyperabduction and external rotation of the shoulder are most usually implicated. [23][24][25] Repetitive injury causes perivenous fibrosis, which eventually leads to thrombosis. Compression of the venous structures that traverse the thoracic outlet occurs in two distinct areas: the scalene triangle and the costoclavicular area.…”

Unique Treatment Regimen for Effort Thrombosis in the Nondominant Extremity of an Overhead Athlete: A Case Report

“…3 Since that time, the evolution of clinical treatment for effort thrombosis has been well documented in the literature. [4][5][6][7][8][9][10] Classically, the treatment of this disorder consisted of bed rest, extremity elevation, and anticoagulation therapy. [4][5][6] High recurrence rates and residual symptoms led to the implementation of more aggressive management with thrombolytics.…”

“…[4][5][6][7][8][9][10] Classically, the treatment of this disorder consisted of bed rest, extremity elevation, and anticoagulation therapy. [4][5][6] High recurrence rates and residual symptoms led to the implementation of more aggressive management with thrombolytics. 4,5,7 More recently, the importance of achieving venous patency by surgical decompression of the axillosubclavian system has been advocated to prevent long-term symptoms.…”