Venous Thoracic Outlet Compression and the Paget-Schroetter Syndrome: A Review and Recommendations for Management

Abstract

Paget Schroetter syndrome, or effort thrombosis of the axillosubclavian venous system, is distinct from other forms of upper limb deep vein thrombosis. It occurs in younger patients and often is secondary to competitive sport, music, or strenuous occupation. If untreated, there is a higher incidence of disabling venous hypertension than was previously appreciated. Anticoagulation alone or in combination with thrombolysis leads to a high rate of rethrombosis. We have established a multidisciplinary protocol over 15 years, based on careful patient selection and a combination of lysis, decompressive surgery, and postoperative percutaneous venoplasty. During the past 10 years, a total of 232 decompression procedures have been performed. This article reviews the literature and presents the Exeter Protocol along with practical recommendations for management.

Venous compression syndromes: clinical features, imaging findings and management

“…PAGET-SCHROETTER SYNDROME Background PSS (otherwise known as thoracic outlet syndrome and previously known as effort thrombosis) is an uncommon cause of DVT of the subclavian vein, most commonly seen as a consequence of chronic compression of the subclavian vein at the level of the thoracic outlet [4,5]. Primary axillary-subclavian vein thrombosis was first described by Paget in 1875 and Von Schroetter in 1884 and it was named the "Paget-Schroetter syndrome" by Hughes [6] in 1948.…”

A Case of Upper Extremity Edema

“…It can lead to chronic venous insufficiency, pain, edema, and hyperpigmentation [5]. Approximately 10 of patients with PSS develop pulmonary embolus [6].…”

“…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]. The timing of these procedures however remains controversial [3].…”

Surgical and Functional Outcomes After Thoracic Outlet Syndrome Decompression via Supraclavicular Approach: A 10-Year Single Centre Experience

“…The objective of treatment is to prevent the recurrence of the thrombosis, which is associated with significant morbidity [21]. Treatment involves an early thrombolytic therapy (within 2 weeks) followed by an anticoagulation (1 -3 months) and delayed surgery [5,20]. Due to logistic reasons we were unable to provide thrombolysis in our institution.…”

“…The most common presentation of vTOS is an axillosubclavian vein thrombosis, which is also known as PagetSchroetter syndrome [3,6,20]. The objective of treatment is to prevent the recurrence of the thrombosis, which is associated with significant morbidity [21].…”