Pharmacomechanical Thrombolysis in the Management of Paget-Schroetter Syndrome

Abstract

Paget-Schroetter syndrome (PSS) is a rare form of thoracic outlet syndrome caused by axillosubclavian vein thrombosis which typically presents in healthy young adults. Prompt therapy, traditionally by means of catheter-directed thrombolysis (CDT) prior to definitive surgery, can prevent the subsequent onset of postthrombotic syndrome (PTS) and considerable disability. As CDT is associated with major haemorrhage and high overall treatment cost, pharmacomechanical thrombectomy (PMT) seems to be an attractive alternative which combines pharmacological thrombolysis with mechanical clot disruption. The Trellis-8 peripheral infusion catheter is an example of such a treatment which provides topical thrombolysis in an isolated zone. We describe the use of the Trellis-8 PMT system in the successful management of three patients with PSS.

Percutaneous thrombectomy in the management of early rethrombosis in venous thoracic outlet syndrome: two case reports

“…Different pharmacomechanical thrombectomy devices have also been successfully used for the treatment of upper extremity deep venous thrombosis (Kärkkäinen et al 2016;Mahmoud et al 2018;Kim et al 2006;Papantoniou et al 2013). When there is a need to avoid or minimize exposure to rtPA, aspiration and mechanical thrombectomy systems can aspirate thrombus without the use of rtPA, resulting in decreased bleeding risk (Teter et al 2020).…”

A Case of Upper Extremity Edema

“…Conventional systemic anticoagulation is a cornerstone of initial therapy. In order to reduce the risk of post-thrombotic syndrome, definitive thrombotic therapy is often necessary utilizing both mechanical thrombectomy and pharmacologic thrombolysis [7]. Definitive surgical correction of the underlying anatomic abnormality is critical to prevent recurrence [4,6].…”

Paget-Schroetter syndrome: A contemporary review of the controversies in management

“…Pharmacomechanical thrombectomy has also been described in the literature a potential alternative or adjunctive therapy for achieving clot lysis. 25,26 The AngioJet TM (Boston Scientific; Massachusetts, USA) thrombectomy system used in conjunction with CDT has been shown to have equivalent outcomes when compared to CDT alone but additionally benefits from shorter treatment duration and reduced use of lytic agent. 27 Early pharmacomechanical thrombectomy with the Trellis-8 TM peripheral infusion system (Medtronic; Minnesota, USA) has demonstrated similarly effective outcomes.…”