scholarly journals Hybrid, Endovascular, or Open Approach -- the Paget Schroetter Syndrome Dilemma

2021 ◽  
Author(s):  
Mohamad Bashir ◽  
Cian Tan ◽  
M Ghali Salahia ◽  
Richard Whiston ◽  
Richard White ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Subclavian Vein ◽  
Hybrid Approach ◽  
Vena Cava ◽  
University Hospital ◽  
Surgical Approaches ◽  
Open Approach ◽  
Extrinsic Compression ◽  
Vena Cava Filters ◽  
Catheter Directed Thrombolysis

Background Paget-Schroetter Syndrome (PSS) is an uncommon disorder involving thrombosis of the subclavian vein, often caused by repetitive overuse or compression by the surrounding anatomical structures. Optimal management of PSS is a subject of debate, but current trends suggest that a hybrid approach employing endovascular intervention and open decompression may yield the best clinical results. This original article examines the roles played by endovascular thrombolysis, surgical decompression, and postoperative secondary intervention in the management of PSS. Methods Current literature on the management of PSS was reviewed and evaluated to ascertain what strategy of intervention would be optimal. In addition, clinical data from the University Hospital of Wales on the clinical outcomes in PSS patients undergoing different surgical approaches for anatomical decompression are included. Results Evaluation of data from the included series and available literature seems to indicate that endovascular thrombolytic devices such as the AngioJet or mechanical thrombectomy offer superior results than traditional catheter-directed thrombolysis. In addition, adjunctive procedures such as superior vena cava filters and venous angioplasty or bypass may augment maintenance of the subclavian vein lumen. Nonetheless, the subclavian vein must still be relieved of pressure from surrounding structures for treatment to be successful. Conclusions A hybrid approach to the management of PSS, encompassing endovascular and surgical interventions could possibly offer optimal clinical outcomes as both intrinsic lesions and extrinsic compression of the subclavian vein are resolved. This article recommends prospective research to determine the ideal endovascular treatment, and best surgical approach for decompression.

scholarly journals The infraclavicular approach for Paget–Schroetter syndrome

2018 ◽  
Vol 100 (2) ◽  
pp. 83-91 ◽  
Author(s):  
G Samoila ◽  
CP Twine ◽  
IM Williams
Keyword(s):  
Subclavian Vein ◽  
Thrombotic Event ◽  
Young Male ◽  
Symptom Duration ◽  
Secondary Patency ◽  
Supraclavicular Approach ◽  
First Rib ◽  
Extrinsic Compression ◽  
Catheter Directed Thrombolysis ◽  
Effort Thrombosis

Introduction Paget–Schroetter syndrome is a rare effort thrombosis of the axillary-subclavian vein, mainly occurring in young male patients. Current management involves immediate catheter directed thrombolysis, followed by surgical decompression of the subclavian vein. This has been invariably performed using a transaxillary or supraclavicular approach. However, the subclavian vein crosses the first rib anteriorly just behind the manubrium and can also be accessed via an infraclavicular incision. Methods MEDLINE® and Embase™ were searched for all studies on outcomes in patients undergoing infraclavicular first rib resection for treatment of Paget–Schroetter syndrome. Measured outcomes included freedom from reintervention, secondary patency and symptom resolution. Studies on neurogenic, arterial and iatrogenic venous thoracic outlet syndrome were not included. Findings Six studies (involving 268 patients) were eligible. The overall secondary venous patency rate was 98.5%. There was freedom from reintervention in 89.9% of cases and among those patients with reocclusion, 84.0% had chronic thrombosis (symptom duration >14 days), with 76.2% having a venous segment stenosis of >2cm. Only 3 of the 27 patients remained occluded despite reintervention. The infraclavicular approach provides excellent exposure to the subclavian vein and allows reconstruction when required. Moreover, this approach enables complete resection of the extrinsic compression that precipitated the initial thrombotic event, with excellent long-term patency rates. In conclusion, the infraclavicular route may have significant advantages compared with the transaxillary or supraclavicular approaches for successful and durable treatment of Paget–Schroetter syndrome.

Medical literature, vena cava filters and evidence of efficacy

2014 ◽  
Vol 111 (04) ◽  
pp. 761-769 ◽  
Author(s):  
Guy Meyer ◽  
Florence Parent ◽  
Patrick Mismetti ◽  
Philippe Girard
Keyword(s):  
Clinical Outcomes ◽  
Case Reports ◽  
Scientific Evidence ◽  
Vena Cava ◽  
Filter Placement ◽  
Significant Relationships ◽  
Vena Cava Filters ◽  
Robust Evidence ◽  
Prior Analysis

SummaryUp to 15% of all patients with venous thromboembolism (VTE) receive an inferior vena cava filter, and prophylactic placements are increasing. To determine whether current use of filters is based on robust evidence, a global review of the recent (2001–2012) literature on filters was undertaken. The MEDLINE database was searched for articles related to filters appearing during the period 2001–2012, updating a prior search of literature from 1975–2001. All retrieved articles were analysed, classified into predetermined categories and compared to the prior analysis; randomised and large (>100 patients with a filter) comparative non-randomised clinical studies were read in full. The 651 articles, vs 568 in the period 1975–2000, consisted mainly of retrospective series (37.8%), case reports (31.7%), reviews (14.7%, vs 6.7%, p<0.001), animal and/or in vitro studies (7.5%, vs 12.9%, p=0.002), and prospective series or trials (4.9%, vs 7.4%, p=0.07). Of 4 new randomised trials (RCT), none were designed to test the efficacy of the device; to date, only one RCT has attempted to ascertain efficacy, occurring during the period 1975–2000. Eleven large non-randomised studies compared clinical outcomes of patients with and without filters, in VTE patients (n=5) or prophylactic indications (n=6); two studies found statistically significant relationships between filter use and lower mortality rates, though none could demonstrate a causal relationship. Hence, the plethoric literature on filters parallels growing experience with these devices, but still fails to provide reliable evidence that filter use improves relevant clinical outcomes. No indication for filter placement is based on appropriate scientific evidence.

A Comparison of Clinical Outcomes with Retrievable and Permanent Inferior Vena Cava Filters

2008 ◽  
Vol 19 (3) ◽  
pp. 393-399 ◽  
Author(s):  
Hyun S. Kim ◽  
Mark J. Young ◽  
Anand K. Narayan ◽  
Kelvin Hong ◽  
Robert P. Liddell ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Clinical Outcomes ◽  
Inferior Vena ◽  
Vena Cava ◽  
Inferior Vena Cava Filters ◽  
Vena Cava Filters

Optional inferior vena cava filters in neurosurgery patients: retrieval rates and clinical outcomes

2014 ◽  
Vol 25 (3) ◽  
pp. S205
Author(s):  
J. Minocha ◽  
L.C. Casadaban ◽  
A. Parvinian ◽  
L. Landers ◽  
M. Knuttinen ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Clinical Outcomes ◽  
Inferior Vena ◽  
Vena Cava ◽  
Inferior Vena Cava Filters ◽  
Vena Cava Filters

A better inferior vena cava filter retrieval rate: A retrospective study in a single-center institution

2020 ◽  
Vol 35 (6) ◽  
pp. 424-429
Author(s):  
Pengkai Cao ◽  
Yunsong Li ◽  
Xiangdong Liu ◽  
Liang Li ◽  
Haitao Li ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Dwell Time ◽  
Inferior Vena ◽  
Vena Cava ◽  
Retrieval Rate ◽  
Large Size ◽  
Vena Cava Filters ◽  
Catheter Directed Thrombolysis ◽  
Medical University

Purpose To determine practice patterns of inferior vena cava filters (IVCFs), retrieval rates, and reasons why retrievable-IVCFs (R-IVCFs) are kept permanent. Methods A total of 399 patients who received IVCFs at Third Hospital of Hebei Medical University from January 2017 to December 2017 were registered and retrospectively studied. Date of demographics, baseline medical history, dwell time, reasons why R-IVCFs were kept permanent, and R-IVCFs thrombus were collected. Results A total of 399 IVCFs were placed during the study period including 27 permanent IVCFs and 372 R-IVCFs. Among all patients who received R-IVCFs, the mean dwell time was 18.25 ± 16.60 days, follow-up rate was 96.24% (358/372), and 337 R-IVCFs were attempted to be removed. Except one, 336 R-IVCFs were retrieved successfully (336/372, 90.32%). Sixty-four R-IVCFs thrombi were found during retrieval including 53 small-size thrombi (< 1 cm × 1 cm) and 13 large-size thrombi (>1 cm × 1 cm). Fifty-three R-IVCFs with small-size thrombi were removed successfully with no additional treatments. Twelve large-size thrombi were retrieved successfully after catheter-directed thrombolysis. Conclusions With good follow-up, the retrieval rate could be improved to 90.32%. The main reasons why R-IVCFs were kept permanent were to avoid losing follow-up and overcome inappropriate selections of indications or IVCF types. And R-IVCFs with thrombus could be removed safely.

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