Paget-Schroetter disease surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]
Overview
Based on pathophysiology of the Paget-Schroetter disease, extrinsic compression and endothelial damage to the vein are among the underlying problems that should be addressed. While thrombolysis only treats acute symptoms, correction surgery decreases recurrence in patients with suspected subclavian vein entrapment. Correction surgery involves both thoracic outlet decompression and restoration of vein patency.
Surgery
- Lee et al. used a treatment approach started with catheter-directed thrombolysis.
- Correction surgery employed for patients with either persistence symptoms or recurrent thrombosis.
- This study delineates that after mean of 13 months follow up, less than 25% of patients required further surgical interventions. [1][2][3][4]
- Correction surgery involves both thoracic outlet decompression and restoration of vein patency.[4]
- J. Ernesto Molina, MD, a vascular surgeon at the University of Minnesota, has expressed the following opinion:[5]
- "The currently acceptable treatment for that condition is lytic therapy followed by surgery. The patients were followed up to investigate the rate of recurrence. However, if surgery is not done, the problem will invariably recur. If patients are treated with only anticoagulants and even thrombolytics but no surgery, I expect the recurrence rate to be high."
- "Most patients who suffer this condition do not have any abnormality in their coagulation mechanism" and in fact suffer from "A direct injury to the endothelium,"
- "Treatment for Paget-Schroetter syndrome entails the use of thrombolytics followed by surgery to decompress the thoracic inlet and widening of the vein, usually with a vein patch."
- Some studies suggest the importance of surgical decompression, since one third of participants who did not underwent surgical decompression experienced re-thrombosis within 30 days.[6]
- Thoracic Outlet Decompression(TOD) applies to first rib and scalenus muscles resection in addition to correction of the costoclavicular ligaments or other abnormalities.[7]
- Urschel and Razzuk manifested 95% good outcome in 199 patients with Paget-Schroetter disease who treated with thrombolysis and first rib resection and have been followed for 20 years.[8]
- Molina et al. reported 5 years of 100% vein patency and complete symptom resolution in patients who treated with thrombolysis and first rib resection.[9]
- There are two approaches for Thoracic Outlet Decompression(TOD):
- Transaxillary approach:
- Quite easier approach.[11]
- Anterior or infraclavicular approach:
- Some studies support this approach as it facilitates better vein repair, since it provides better access to the proximal subclavian and innominate veins.[12]
- Transaxillary approach:
- There are some reported complications of Thoracic Outlet Decompression(TOD):
- Pneumothorax
- Bleeding
- Nerve injury
- Arterial injury
- The best time for surgery has been controversial, nevertheless there are some studies that reported the best outcomes with thrombolysis followed by early surgery.[13]
- Some interventions like surgical thrombectomy, balloon venoplasty and stenting to reclaim the vein patency all have been abandoned due to high morbidity.[14]
- In some patients with remaining thrombosis after thoracic outlet decompression patch venoplasty and venous bypass have been effective. [15]
- Angioplasty or stenting before decompression surgery have been failed in many cases.[16]
References
- ↑ Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK (2010). "Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis". West J Emerg Med. 11 (4): 358–62. PMC 2967689. PMID 21079709.
- ↑ Illig, Karl A.; Doyle, Adam J. (2010). "A comprehensive review of Paget-Schroetter syndrome". Journal of Vascular Surgery. 51 (6): 1538–1547. doi:10.1016/j.jvs.2009.12.022. ISSN 0741-5214.
- ↑ Rosa Salazar, Vladimir; Otálora Valderrama, Sonia del Pilar; Hernández Contreras, María Encarnación; García Pérez, Bartolomé; Arroyo Tristán, Andrés del Amor; García Méndez, María del Mar (2015). "Multidisciplinary Management of Paget-Schroetter Syndrome. A Case Series of Eight Patients". Archivos de Bronconeumología (English Edition). 51 (8): e41–e43. doi:10.1016/j.arbr.2015.05.026. ISSN 1579-2129.
- ↑ 4.0 4.1 Molina JE, Hunter DW, Dietz CA (2009). "Protocols for Paget-Schroetter syndrome and late treatment of chronic subclavian vein obstruction". Ann Thorac Surg. 87 (2): 416–22. doi:10.1016/j.athoracsur.2008.11.056. PMID 19161749.
- ↑ "Letter Regarding Article by Martinelli et al, "Risk Factors and Recurrence Rate of Primary Deep Vein Thrombosis of the Upper Extremities" * Response -- Molina et al. 111 (9): e118 -- Circulation". Retrieved 2007-07-02.
- ↑ Illig, Karl A.; Doyle, Adam J. (2010). "A comprehensive review of Paget-Schroetter syndrome". Journal of Vascular Surgery. 51 (6): 1538–1547. doi:10.1016/j.jvs.2009.12.022. ISSN 0741-5214.
- ↑ Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK (2010). "Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis". West J Emerg Med. 11 (4): 358–62. PMC 2967689. PMID 21079709.
- ↑ Illig, Karl A.; Doyle, Adam J. (2010). "A comprehensive review of Paget-Schroetter syndrome". Journal of Vascular Surgery. 51 (6): 1538–1547. doi:10.1016/j.jvs.2009.12.022. ISSN 0741-5214.
- ↑ Molina, J. Ernesto; Hunter, David W.; Dietz, Charles A. (2007). "Paget-Schroetter syndrome treated with thrombolytics and immediate surgery". Journal of Vascular Surgery. 45 (2): 328–334. doi:10.1016/j.jvs.2006.09.052. ISSN 0741-5214.
- ↑ "Effort Thrombosis Presenting as Pulmonary Embolism in a Professional Baseball Pitcher".
- ↑ Urschel, Harold C.; Patel, Amit N. (2008). "Surgery Remains the Most Effective Treatment for Paget-Schroetter Syndrome: 50 Years' Experience". The Annals of Thoracic Surgery. 86 (1): 254–260. doi:10.1016/j.athoracsur.2008.03.021. ISSN 0003-4975.
- ↑ Molina JE, Hunter DW, Dietz CA (2009). "Protocols for Paget-Schroetter syndrome and late treatment of chronic subclavian vein obstruction". Ann Thorac Surg. 87 (2): 416–22. doi:10.1016/j.athoracsur.2008.11.056. PMID 19161749.
- ↑ . doi:10.1016/j.arbr.2015.05.026 : Check
|doi=value (help). Missing or empty|title=(help) - ↑ Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK (2010). "Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis". West J Emerg Med. 11 (4): 358–62. PMC 2967689. PMID 21079709.
- ↑ Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK (2010). "Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis". West J Emerg Med. 11 (4): 358–62. PMC 2967689. PMID 21079709.
- ↑ Illig, Karl A.; Doyle, Adam J. (2010). "A comprehensive review of Paget-Schroetter syndrome". Journal of Vascular Surgery. 51 (6): 1538–1547. doi:10.1016/j.jvs.2009.12.022. ISSN 0741-5214.