Lara Sak, Thomas Munro, Jesus Ulloa, Hugh A Gelabert
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引用次数: 0
Abstract
Objective: Acute subclavian vein thrombosis secondary to thoracic outlet syndrome (Paget-Schroetter syndrome [PSS]) requires the prompt clearing of thrombus from the subclavian vein through catheter-directed thrombolysis (CDT) or aspiration thrombectomy (ASP). Our goal is to systematically compare the outcomes of CDT and ASP in the management of PSS.
Methods: Consecutive patients with PSS at a single institution from 2020 through 2025 were reviewed for management with CDT or ASP. Venograms were assessed for patency, stenosis, and subclavian post-thrombotic changes (PTC). PTC were graded based on the degree of luminal encroachment and vessel irregularity: mild (<10%), moderate (10%-50%), and severe (50%-99%). Interventions were assessed: (1) within 1 week of the procedure, (2) before subclavian vein decompression, (3) 2 weeks after subclavian vein decompression, and (4) patency on the last venogram. Standardized outcomes were assessed.
Results: A total of 110 patients with PSS were treated over 5 years. Of these patients, 54 met the inclusion criteria: 28 underwent CDT and 26 underwent ASP. At 1 week following the procedure, rethrombosis occurred in 1 (3.6%) patient who underwent CDT and 6 (23.1%) patients who underwent ASP (P < .5). Failure to clear thrombosis occurred in 13.8% of patients who underwent ASP. The composite rate of early thrombosis and procedural failure was higher in the ASP cohort. Before PSS surgery, occlusion was noted in 1 (3.6%) patient who underwent CDT and 8 (30.8%) patients who underwent ASP (P < .05). PTC was mild in 13 (46.4%) patients receiving CDT and 5 (19.2%) receiving ASP (P < .05); moderate in 5 (17.9%) receiving CDT and 5 (19.2%) receiving ASP; and severe in 9 (32.1%) receiving CDT and 8 (30.8) receiving ASP. At early follow-up after PSS surgery, PTC was mild in 10 (43.5%) patients receiving CDT and 4 (23.5) receiving ASP; moderate in 2 (8.7%) receiving CDT and 1 (5.9%) receiving ASP; and severe in 9 (39.1%) receiving CDT and 6 (35.3%) receiving ASP. Occlusion was noted in 2 (8.7%) patients receiving CDT and 6 (35%) receiving ASP. Recanalization resulted in final patency in 22 (95%) patients receiving CDT and 15 (88%) receiving ASP.
Conclusions: Both ASP and CDT may be employed for clearing thrombus in PSS; however, they differ in early efficacy, PTC, and patency. Our results suggest that while often more rapid and convenient, ASP may be inferior to CAT in the management of PSS.
期刊介绍：
Journal of Vascular Surgery: Venous and Lymphatic Disorders is one of a series of specialist journals launched by the Journal of Vascular Surgery. It aims to be the premier international Journal of medical, endovascular and surgical management of venous and lymphatic disorders. It publishes high quality clinical, research, case reports, techniques, and practice manuscripts related to all aspects of venous and lymphatic disorders, including malformations and wound care, with an emphasis on the practicing clinician. The journal seeks to provide novel and timely information to vascular surgeons, interventionalists, phlebologists, wound care specialists, and allied health professionals who treat patients presenting with vascular and lymphatic disorders. As the official publication of The Society for Vascular Surgery and the American Venous Forum, the Journal will publish, after peer review, selected papers presented at the annual meeting of these organizations and affiliated vascular societies, as well as original articles from members and non-members.
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