Pharmacomechanical Thrombectomy in Paget–Schroetter Syndrome

• Published in: Cardiovascular and interventional radiology Vol. 39; no. 9; pp. 1272 - 1279
• Main Authors: Kärkkäinen, Jussi M., Nuutinen, Henrik, Riekkinen, Teemu, Sihvo, Eero, Turtiainen, Johanna, Saari, Petri, Mäkinen, Kimmo, Manninen, Hannu
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2016; Springer Nature B.V
• Subjects: Adolescent; Adult; BALLOONS; BIOMEDICAL RADIOGRAPHY; Cardiology; Clinical Investigation; Combined Modality Therapy; Decompression, Surgical; Feasibility Studies; Female; Fibrinolytic Agents - administration & dosage; HANDS; Humans; Imaging; INFUSION; LYSIS; Male; Medicine; Medicine & Public Health; Middle Aged; Nuclear Medicine; PATIENTS; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; REMOVAL; REPAIR; Subclavian Vein - diagnostic imaging; Subclavian Vein - surgery; SURGERY; Thrombectomy - methods; TOTAL ENERGY SYSTEMS; Treatment Outcome; Ultrasonography, Doppler, Duplex; Ultrasound; Upper Extremity Deep Vein Thrombosis - diagnostic imaging; Upper Extremity Deep Vein Thrombosis - surgery; VEINS; Young Adult; Paget–Schroetter syndrome; Pharmacomechanical thrombectomy; Thoracic surgical decompression; Pulmonary embolism; Mechanical thrombectomy; Thoracoscopic first rib resection; Subclavian vein thrombosis
• ISSN: 0174-1551; 1432-086X
• DOI: 10.1007/s00270-016-1376-4

Purpose The purpose of the study was to evaluate feasibility of pharmacomechanical thrombectomy (PMT) in the treatment of Paget–Schroetter syndrome (PSS) followed by thoracoscopic or open surgical decompression of the subclavian vein. Methods Twenty-two out of 27 consecutive patients with PSS received PMT using the Trellis-8 peripheral infusion system (Covidien) between 2010 and 2014. Subsequent surgery was performed in 18 of those patients, 9 patients were treated with thoracoscopic, 7 patients with subclavicular, and 2 patients with transaxillary first rib resection, 4 patients were treated with PMT and anticoagulation alone. Technical success, complications, and patency were registered. Results PMT was successful in 21 (95 %) patients; 1 patient with unsatisfactory lysis received further catheter-directed thrombolysis, which, however, did not improve the result. The mean endovascular procedure time was 105 ± 33 min (range 70–200 min), and the required median amount of thrombolytic agent was 500,000 international unit (IU; range 250,000–1,000,000 IU). Adjunctive balloon venoplasty and aspiration were used in 18 (82 %) and 7 (32 %) cases, respectively. One patient had an intimal tear of the subclavian vein that was discovered and repaired during surgery. There were no other complications related to the endovascular procedure. At follow-up, 18 of 21 patients (86 %) with follow-up imaging available had patent subclavian vein, and all except 1 of the 22 patients were asymptomatic. The mean follow-up time was 25 ± 17 months. Conclusions In experienced hands, PMT is effective for early thrombus removal in PSS. Surgical decompression must be considered after PMT.