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Sukovatykh BS, Sereditsky AV, Muradyan VF, Sukovatykh MB, Bolomatov NV, Gordov MY. [Endovascular treatment of deep vein thrombosis of the upper extremities]. Khirurgiia (Mosk) 2024:45-51. [PMID: 38344959 DOI: 10.17116/hirurgia202402145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
OBJECTIVE To improve the results of treatment of deep vein thrombosis of the upper extremities sing endovascular technologies. MATERIAL AND METHODS We analyzed safety and effectiveness of treatment in 24 patients with deep vein thrombosis of the upper extremities. All ones were divided into 2 homogeneous groups by 12 people each. In the first group, conventional anticoagulation was performed. In the second group, we used additional regional catheter thrombolysis with alteplase and, if necessary, venous stenting or balloon angioplasty for residual stenosis. Patients received apixaban at baseline and throughout 6 postoperative months. After 12 months, we performed ultrasound and clinical examination to identify deep vein patency and venous outflow disorders. Vein recanalization was evaluated as follows: <50% - minimal, 50-99% - partial, 100% - complete. The quality of life of patients was studied using the SF-36 questionnaire. RESULTS In the first group, we observed complete vein recanalization in 25% of cases, partial - in 33%, minimal - in 41% of cases; in the second group - 83.3% and 16.7% of patients, respectively. In the first group, clinical manifestations of venous outflow disorders were absent in 25% of patients, mild disorders - 25%, moderate - 8.3%, severe - 41.7% of patients. In the second group, venous outflow was not impaired in 83.7% of patients, mild violations occurred in 16.7% of patients. In the first group, physical health was equal to 44.2±1.7 scores, psychological health - 49.3±2.3 scores; in the second group - 69.3±5.7 and 71.3±5.4 scores, respectively. CONCLUSION Endovascular treatment improved postoperative outcomes.
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Affiliation(s)
| | | | | | | | - N V Bolomatov
- Kursk City Clinical Emergency Hospital, Kursk, Russia
| | - M Y Gordov
- Kursk City Clinical Emergency Hospital, Kursk, Russia
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Abbott A, Siemers B, Siddiqui H. Circumferential Arm Swelling in an Elite Adolescent Baseball Player. Pediatr Rev 2023; 44:595-597. [PMID: 37777647 DOI: 10.1542/pir.2021-005380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Alexandra Abbott
- Pediatrics Residency Program and Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, CA
- Division of Pediatric Hospital Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Brittany Siemers
- Pediatrics Residency Program and Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, CA
- Division of Pediatric Hospital Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA
| | - Hanna Siddiqui
- Pediatrics Residency Program and Department of Pediatrics, UCLA Mattel Children's Hospital, Los Angeles, CA
- Division of Pediatric Hospital Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA
- UCLA Santa Monica Medical Center, Santa Monica, CA
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Heo J, Medani K, Juma H. Paget-Schroetter syndrome from manual handling at work: Case report and review of the literature. Am J Ind Med 2022; 65:281-285. [PMID: 35195925 DOI: 10.1002/ajim.23337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 11/11/2022]
Abstract
Paget-Schroetter syndrome (PSS) is a primary deep venous thrombosis of the subclavian-axillary vein complex occurring after repetitive and strenuous use of the shoulders and arms. Here, we report the case of a 24-year-old man who presented with left subclavian and axillary vein thrombosis after loading and unloading labor, who was diagnosed with PSS confirmed with Doppler ultrasound, and treated with anticoagulation. By comparing our case with 45 published case reports, we also aim to analyze patient characteristics, diagnostic methods, and treatment options for the disorder.
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Affiliation(s)
- Jaeyeong Heo
- Division of Environmental and Occupational Health Sciences University of Illinois at Chicago School of Public Health Chicago Illinois USA
| | - Khalid Medani
- Department of Occupational Medicine Concentra Urgent Care Inc. Moreno Valley California USA
| | - Haitham Juma
- Department of Occupational Medicine Loma Linda University Medical Center Loma Linda California USA
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Karaolanis G, Antonopoulos CN, Koutsias SG, Giosdekos A, Metaxas EK, Tzimas P, de Borst GJ, Geroulakos G. A systematic review and meta-analysis for the management of Paget-Schroetter syndrome. J Vasc Surg Venous Lymphat Disord 2021; 9:801-810.e5. [PMID: 33540134 DOI: 10.1016/j.jvsv.2021.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/21/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE There is currently no general agreement on the optimal treatment of Paget-Schroetter syndrome. Most centers have advocated an interventional approach that is based on the results of small institutional series. The purpose of our meta-analysis was to focus on the safety and efficacy of thrombolysis or anticoagulation with decompression therapy. A detailed description of the epidemiologic, etiologic, and clinical characteristics, along with radiologic findings and treatment option details, was also performed. METHODS The current meta-analysis was conducted using the PRISMA guidelines. Studies reporting on spontaneous thrombosis or thrombosis after strenuous activities of axillary-subclavian vein were considered eligible. Analyses of all retrospective studies were conducted, and pooled proportions with 95% confidence intervals of outcome rates were calculated. RESULTS Twenty-five studies with 1511 patients were identified. Among these patients, 1177 (77.9%) had thrombolysis, 658 (43.5%) had anticoagulation, and 1293 (85.6%) patients had decompression therapy of the thoracic outlet. Complete thrombus resolution was estimated at 78.11% of the patients after thrombolysis, and the respective pooled proportion for partial resolution of thrombus was 23.72%. Despite thrombolytic therapy, 212 patients underwent additional balloon angioplasty for residual stenosis, although only 36 stents were implanted. After anticoagulation, a total of 40.70% of the patients had complete thrombus resolution, whereas partial resolution was occurred in 29.13% of the patients. During follow-up, a total of 51.75% of the patients with any initial treatment modality had no remaining thrombus, and 84.87% of these patients were free of symptoms. We also estimated that 76.88% of the patients had a Disabilities of the Arm, Shoulder and Hand score of <20, indicating no or mild symptoms after treatment. A subgroup meta-analysis with 20 studies and 1309 patients, showed significantly improved vein patency and symptom resolution in patients who had first rib resection with or without venoplasty, compared with those who had only thrombolysis. CONCLUSIONS Although no randomized controlled data are available, our analysis strongly suggested higher rates of thrombus and symptoms resolution with thrombolysis, followed by first rib resection. A prospective randomized trial comparing anticoagulants with thrombolysis and decompression of thoracic outlet is required.
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Affiliation(s)
- Georgios Karaolanis
- Vascular Unit, Department of Surgery, University Hospital of Ioannina and School of Medicine, Ioannina, Greece.
| | - Constantine N Antonopoulos
- Cardiothoracic and Vascular Surgery Department, General Hospital of Athens "Evangelismos", Athens, Greece; Department of Vascular Surgery, Athens University Medical School, Athens, Greece
| | - Stylianos G Koutsias
- Vascular Unit, Department of Surgery, University Hospital of Ioannina and School of Medicine, Ioannina, Greece
| | - Alexandros Giosdekos
- Department of Vascular Surgery, Athens University Medical School, Athens, Greece
| | | | - Petros Tzimas
- Department of Anesthesiology, University Hospital of Ioannina and School of Medicine, Ioannina, Greece
| | - Gert J de Borst
- Department of Vascular Surgery, UMC, Utrecht, The Netherlands
| | - George Geroulakos
- Department of Vascular Surgery, Athens University Medical School, Athens, Greece
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Tanabe H, Miyamori D, Shigenobu Y, Ito Y, Kametani T, Kakimoto M, Kawahara A, Kikuchi Y, Kobayashi T, Otani Y, Kishikawa N, Kanno K, Ito M. Two Patients with Paget-Schroetter Syndrome That Were Successfully Diagnosed by Doppler Ultrasonography: Case Studies with a Literature Review. Intern Med 2020; 59:2623-2627. [PMID: 32581157 PMCID: PMC7662054 DOI: 10.2169/internalmedicine.4349-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
We herein report on two male patients (age, 22 and 44 years) who were referred to our department with swelling of the upper right arm after attending other hospitals. Right subclavian vein thrombosis was demonstrated by ultrasonography and they were then further evaluated by contrast-enhanced computed tomography (CT). Successful treatment involved venous thrombectomy in one patient and anticoagulant therapy in the other. Paget-Schhroetter syndrome was confirmed using standard vascular ultrasonography. Despite the accuracy of this method for diagnosing Paget-Schroetter syndrome, some cases are difficult to confirm. We reviewed 29 previously published case reports of Paget-Schroetter syndrome and analyzed the patient baseline characteristics, time to diagnosis, and the diagnostic methods used.
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Affiliation(s)
- Hiromasa Tanabe
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Daisuke Miyamori
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Yuya Shigenobu
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Yayoiko Ito
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Takahiro Kametani
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Masaki Kakimoto
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Akihiro Kawahara
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Yuka Kikuchi
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Tomoki Kobayashi
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Yuichiro Otani
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Nobusuke Kishikawa
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Keishi Kanno
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
| | - Masanori Ito
- Department of General Internal Medicine, Hiroshima University Hospital, Japan
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Osman M, Afridi FG, Sidawy AN, Lala S. Paget-Schroetter syndrome in pregnancy: A case report and discussion of management options. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:59-62. [PMID: 32072090 PMCID: PMC7016339 DOI: 10.1016/j.jvscit.2019.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 11/21/2019] [Indexed: 11/30/2022]
Abstract
Paget-Schroetter syndrome is a form of primary venous thoracic outlet syndrome whereby thrombosis of the subclavian vein is instigated by repeated and vigorous overhead activity of the arm. We describe a 35-year-old pregnant white woman at 8 weeks' gestation, a competitive swimmer by profession, who was diagnosed with a left upper extremity thrombus. First rib resection through an infraclavicular approach was performed 1 week after percutaneous pharmacomechanical thrombectomy. Repeated venography demonstrated residual thrombus requiring percutaneous pharmacomechanical thrombectomy with balloon venoplasty. We present a challenging case with focus on the unique diagnostic evaluation and management of pregnant patients with this condition.
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Affiliation(s)
- Murat Osman
- George Washington University School of Medicine and Health Sciences, Washington, D.C
| | - Faryal G Afridi
- Division of Vascular Surgery, Department of Surgery, George Washington University, Washington, D.C
| | - Anton N Sidawy
- Division of Vascular Surgery, Department of Surgery, George Washington University, Washington, D.C
| | - Salim Lala
- Division of Vascular Surgery, Department of Surgery, George Washington University, Washington, D.C
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Overview of venous pathology related to repetitive vascular trauma in athletes. J Vasc Surg Venous Lymphat Disord 2019; 7:756-762. [PMID: 31231058 DOI: 10.1016/j.jvsv.2019.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/29/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Athletes are generally young, high-functioning individuals. Pathology in this cohort is associated with a decrease in function and consequently has major implications on quality of life. Venous disorders can be attributed to a combination of vascular compression with a high burden of activity. OBJECTIVE This article promotes increased awareness of these uncommon conditions specific to the athlete by summarizing pathophysiology, clinical features, investigation, and treatment protocols for use in clinical practice. Prognostic outcomes of these management regimens are also discussed, allowing for clinicians to counsel these high-functioning individuals appropriately. With the aim of providing an overview of sport-related venous pathology, a literature review was undertaken identifying articles that were independently reviewed by the authors. RESULTS Lower limb venous thrombosis has been identified in young, high-functioning athletes attributed to both compression-related venous trauma, associated with repetitive movements resulting in intimal damage, and blunt trauma. The diagnosis and treatment follow the same protocols as for the general population. Of note, early ambulation is advocated, with an aim to return to premorbid (noncontact) function within 6 weeks. Athletes performing high-intensity repetitive upper limb movement, such as baseball players, are predisposed to upper limb deep venous thrombosis (DVT). Diagnosis follows the same protocols as for lower extremity DVT; however, the optimal treatment strategy remains debated. Current guidelines advocate the use of anticoagulation alone. A specific subset of primary upper limb DVT is effort thrombosis, where there is compression at the level of the thoracic outlet. Thrombolysis with first rib resection is indicated in the acute setting within 14 days. In cases of complete occlusion, surgical decompression with venous reconstruction may be required. Popliteal vein entrapment syndrome is also discussed. This entity has been identified as an overuse injury associated with popliteal vein compression. Duplex ultrasound examination is indicated as a first-line investigation, with conservative noninvasive options considered as an initial management strategy. Chronic venous insufficiency or persistent symptoms may require subsequent surgical decompression. CONCLUSIONS Key conditions including upper extremity and lower extremity venous thrombosis, venous aneurysms, Paget-Schroetter syndrome (effort thrombosis), and popliteal vein entrapment syndrome are discussed. Further studies evaluating long-term outcomes on morbidity for current treatment regimens in upper extremity DVT, effort thrombosis, venous thoracic outlet syndrome, and popliteal venous entrapment syndrome are required.
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Mahajerin A, Betensky M, Goldenberg NA. Thrombosis in Children: Approach to Anatomic Risks, Thrombophilia, Prevention, and Treatment. Hematol Oncol Clin North Am 2019; 33:439-453. [PMID: 31030812 DOI: 10.1016/j.hoc.2019.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pediatric venous thromboembolism (VTE) is increasing in incidence but minimal data exist for best practices regarding therapy, use of thrombophilia testing, and management of long-term complications. Classification schema use anatomic location and presence of clinical or thrombophilic inciting factors. There are a small number of risk-assessment and risk-modeling systems for incident VTE, but all suffer from low numbers, single-institution design, and lack of prospective validation. Acute treatment is limited to heparin products and thrombolysis may be indicated in specific situations. In addition, chronic postthrombotic comorbidities are expected to increase in incidence and lack evidence-based treatment paradigms.
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Affiliation(s)
- Arash Mahajerin
- Division of Hematology, 1201 West La Veta Avenue, Orange, CA 92868, USA.
| | - Marisol Betensky
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Pediatric Thrombosis Program, Johns Hopkins All Children's Cancer and Blood Disorder Institute, Johns Hopkins Medicine, 600 5th Street South, 4th Floor, St Petersburg, FL 33701, USA
| | - Neil A Goldenberg
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Medicine, Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Pediatric Thrombosis Program, Johns Hopkins All Children's Hospital, Johns Hopkins All Children's Cancer and Blood Disorder Institute, Johns Hopkins Medicine, 600 5th Street South, 3rd Floor, St Petersburg, FL 33701, USA; Johns Hopkins Children's Center, Baltimore, MD, USA
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Mahmoud O, Sihvo E, Räsänen J, Vikatmaa L, Vikatmaa P, Venermo M. Treatment of Paget-Schroetter syndrome with a three-stage approach including thoracoscopic rib resection at the second stage. J Vasc Surg Venous Lymphat Disord 2018; 6:75-82. [DOI: 10.1016/j.jvsv.2017.07.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 07/28/2017] [Indexed: 11/30/2022]
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10
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Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest 2016; 149:315-352. [PMID: 26867832 DOI: 10.1016/j.chest.2015.11.026] [Citation(s) in RCA: 3289] [Impact Index Per Article: 411.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 11/24/2015] [Accepted: 11/25/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND We update recommendations on 12 topics that were in the 9th edition of these guidelines, and address 3 new topics. METHODS We generate strong (Grade 1) and weak (Grade 2) recommendations based on high- (Grade A), moderate- (Grade B), and low- (Grade C) quality evidence. RESULTS For VTE and no cancer, as long-term anticoagulant therapy, we suggest dabigatran (Grade 2B), rivaroxaban (Grade 2B), apixaban (Grade 2B), or edoxaban (Grade 2B) over vitamin K antagonist (VKA) therapy, and suggest VKA therapy over low-molecular-weight heparin (LMWH; Grade 2C). For VTE and cancer, we suggest LMWH over VKA (Grade 2B), dabigatran (Grade 2C), rivaroxaban (Grade 2C), apixaban (Grade 2C), or edoxaban (Grade 2C). We have not changed recommendations for who should stop anticoagulation at 3 months or receive extended therapy. For VTE treated with anticoagulants, we recommend against an inferior vena cava filter (Grade 1B). For DVT, we suggest not using compression stockings routinely to prevent PTS (Grade 2B). For subsegmental pulmonary embolism and no proximal DVT, we suggest clinical surveillance over anticoagulation with a low risk of recurrent VTE (Grade 2C), and anticoagulation over clinical surveillance with a high risk (Grade 2C). We suggest thrombolytic therapy for pulmonary embolism with hypotension (Grade 2B), and systemic therapy over catheter-directed thrombolysis (Grade 2C). For recurrent VTE on a non-LMWH anticoagulant, we suggest LMWH (Grade 2C); for recurrent VTE on LMWH, we suggest increasing the LMWH dose (Grade 2C). CONCLUSIONS Of 54 recommendations included in the 30 statements, 20 were strong and none was based on high-quality evidence, highlighting the need for further research.
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