ArticleJournal of vascular surgery. Venous and lymphatic disorders2026
Midterm outcomes after delayed first rib resection for acute axillosubclavian deep vein thrombosis in Paget-Schroetter syndrome.
Article in Journal of vascular surgery. Venous and lymphatic disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThe standard treatment for axillosubclavian deep venous thrombosis (DVT) in patients with Paget-Schroetter syndrome typically includes thrombolysis, first rib resection (FRR), and, when needed, percutaneous transluminal venoplasty (PTV) or stenting. Our institution adopted a simplified approach using anticoagulation alone followed by delayed FRR (3-6 months) without thrombolysis. This study evaluates its clinical effectiveness.
methodsWe conducted a retrospective cohort study of patients who underwent FRR for upper-extremity DVT in Paget-Schroetter syndrome between January 2017 and July 2024, using a prospectively maintained database. The primary end point was postoperative clinical improvement. We also analyzed patient demographics, venous involvement, hypercoagulable status, and anticoagulation duration.
resultsOf 27 identified patients, eight who underwent thrombolysis were excluded. Among the 19 patients (mean age, 28.4 years; 13 males), all presented with arm swelling and pain. The subclavian vein was involved in 15 patients and the axillary vein in four. Eleven patients were involved in competitive sports. Mean preoperative anticoagulation duration was 5.9 ± 2.1 months and was discontinued postoperatively. Most patients underwent transaxillary FRR. Postoperative duplex showed complete DVT resolution in 16 patients and partial or chronic DVT in three. Four patients required intraoperative PTV for symptomatic stenosis. At a mean follow-up of 20.3 ± 22.1 months, 17 patients were symptom-free, whereas two patients required additional PTV.
conclusionsAnticoagulation followed by delayed FRR provides effective short-term symptom relief. Avoiding thrombolysis simplifies management and may reduce risks and costs while maintaining favorable outcomes. Further studies are needed to assess long-term efficacy.
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