Percutaneous Mechanical Thrombectomy for the Management of Venous Thoracic Outlet Syndrome

Abstract BackgroundVenous thoracic outlet syndrome resulting in the upper limb deep venous thrombosis is known as Paget–Schroetter syndrome or effort thrombosis. A general treatment algorithm includes catheter-directed thrombolysis followed by surgical thoracic outlet decompression. There are limited data regarding endovascular treatment of rethrombosis presenting early after the surgery.Case presentationTwo cases of early rethrombosis successfully treated with percutaneous mechanical thrombectomy by two different techniques are described. In both cases, rethrombosis was diagnosed soon after thrombolysis and first rib resection with scalenectomy. After 6 months, both patients remain symptom-free, with patent subclavian veins confirmed by duplex ultrasonography. ConclusionPercutaneous mechanical thrombectomy devices may offer a safe treatment option for patients with recurrent thrombosis after thoracic outlet surgery, even when thrombolytic therapy is contraindicated.

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Percutaneous Mechanical Thrombectomy for the Management of Venous Thoracic Outlet Syndrome

Journal of Endovascular Therapy ◽

10.1177/152660280301000226 ◽

2003 ◽

Vol 10 (2) ◽

pp. 336-340 ◽

Cited By ~ 11

Author(s):

Darren B. Schneider ◽

Thomas K. Curry ◽

Charles M. Eichler ◽

Louis M. Messina ◽

Roy L. Gordon ◽

...

Keyword(s):

Case Report ◽

Thrombolytic Therapy ◽

Subclavian Vein ◽

Thoracic Outlet Syndrome ◽

Mechanical Thrombectomy ◽

Recurrent Thrombosis ◽

Percutaneous Mechanical Thrombectomy ◽

Vein Thrombosis ◽

Subclavian Vein Thrombosis ◽

Arm Swelling

Purpose: To describe the successful use of percutaneous mechanical thrombectomy as an adjunct to thrombolysis for acute subclavian vein thrombosis due to venous thoracic outlet syndrome Case Report: A 40-year-old man presented with arm swelling due to acute subclavian vein thrombosis and venous thoracic outlet syndrome. Percutaneous mechanical thrombectomy with the AngioJet device and thrombolysis were used to restore venous patency. Immediately following operative thoracic outlet decompression, the patient experienced rethrombosis, which was successfully treated using percutaneous mechanical thrombectomy. After 6 months, the patient remains symptom-free, with a patent subclavian vein by duplex ultrasonography. Conclusions: Thrombus debulking or removal with percutaneous mechanical thrombectomy devices may reduce the amount or duration of thrombolytic therapy required, making treatment of venous thoracic outlet syndrome safer. Moreover, patients with recurrent thrombosis after thoracic outlet decompression may be safely treated with percutaneous mechanical thrombectomy, even when thrombolytic therapy is contraindicated.

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

CVIR Endovascular ◽

10.1186/s42155-021-00250-6 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Ján Sýkora ◽

Kamil Zeleňák ◽

Martin Vorčák ◽

Adam Krkoška ◽

Štefánia Vetešková ◽

...

Keyword(s):

Thoracic Outlet Syndrome ◽

Mechanical Thrombectomy ◽

Case Reports ◽

Treatment Algorithm ◽

Limited Data ◽

Case Presentation ◽

Percutaneous Mechanical Thrombectomy ◽

Catheter Directed Thrombolysis ◽

Effort Thrombosis ◽

First Rib Resection

Abstract Background Venous thoracic outlet syndrome resulting in the upper limb deep venous thrombosis is known as Paget–Schroetter syndrome or effort thrombosis. A general treatment algorithm includes catheter-directed thrombolysis followed by surgical thoracic outlet decompression. There are limited data regarding endovascular treatment of rethrombosis presenting early after the surgery. Case presentation Two cases of early rethrombosis successfully treated with percutaneous mechanical thrombectomy by two different techniques are described. In both cases, rethrombosis was diagnosed soon after thrombolysis and first rib resection with scalenectomy. After 12 months, both patients remain symptom-free, with patent subclavian veins confirmed by duplex ultrasonography. Conclusion Percutaneous mechanical thrombectomy devices may offer a safe treatment option for patients with recurrent thrombosis after thoracic outlet surgery, even when thrombolytic therapy is contraindicated.

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Percutaneous mechanical thrombectomy in the treatment of acute and subacute occlusions of the peripheral arteries and bypasses

VASA ◽

10.1024/0301-1526/a000495 ◽

2016 ◽

Vol 45 (1) ◽

pp. 49-56 ◽

Cited By ~ 10

Author(s):

Frantisek Stanek ◽

Radoslava Ouhrabkova ◽

David Prochazka

Keyword(s):

Mechanical Thrombectomy ◽

Clinical Success ◽

Major Amputation ◽

Peripheral Arteries ◽

Duration Of Symptoms ◽

Efficient Treatment ◽

Percutaneous Mechanical Thrombectomy ◽

Single Centre Study ◽

Crural Arteries

Abstract. Background: The aim of this prospective single-centre study was to analyse the immediate results, failures and complications of percutaneous mechanical thrombectomy using the Rotarex catheter in the treatment of acute and subacute occlusions of peripheral arteries and bypasses, as well as to evaluate long-term outcomes of this method. Patients and methods: Patients with acute (duration of symptoms < 14 days) or subacute (duration of symptoms > 14 days and < 3 months) occlusions of peripheral arteries and bypasses were selected consecutively for treatment. The cohort consisted of 113 patients, aged 18 - 92 years (median 72 years). In all, 128 procedures were performed. Results: Angiographic success was obtained in 120 interventions (93.8 %). Reasons for failures were rethrombosis of a partially recanalised segment in six procedures, and embolism into crural arteries in one intervention - percutaneous aspiration thromboembolectomy (PAT) and/or thrombolysis were ineffective in all these cases. Breakage of the Rotarex catheter happened in one procedure. Embolisation into crural arteries as a transitory complication solvable with PAT and/or thrombolysis occurred in four cases. Rethrombosis was more frequent in bypasses than in native arteries (p = 0.0069), in patients with longer occlusions (p = 0.026) and those with poorer distal runoff (p = 0.048). Embolisation happened more often in patients with a shorter duration of symptoms (p = 0.0001). Clinical success was achieved in 82.5 %. Major amputation was performed in 10 % of cases. Cumulative patency rates were 75 % after one month, 71 % after six months, 38 % after 12 months, 33 % after 18 months and 30 % after 24, 30, 36 and 42 months. Conclusions: Rotarex thrombectomy has excellent immediate results with a low rate of failures and complications. In comparison to thrombolysis, it enables the fast and efficient treatment of acute and subacute occlusions of peripheral arteries in one session.

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