TY - JOUR
TI - A systematic review and meta-analysis for the management of
Paget-Schroetter syndrome
AU - Karaolanis, Georgios
AU - Antonopoulos, Constantine N.
AU - Koutsias,
AU - Stylianos G.
AU - Giosdekos, Alexandros
AU - Metaxas, Efstathios K. and
AU - Tzimas, Petros
AU - de Borst, Gert J.
AU - Geroulakos, George
JO - Journal of Vascular Surgery: Venous and Lymphatic Disorders
PY - 2021
VL - 9
TODO - 3
SP - 801+
PB - Elsevier
SN - 2213-333X
TODO - 10.1016/j.jvsv.2021.01.011
TODO - Paget-Schroetter syndrome; Effort; Thrombosis; Meta-analysis; Review
TODO - 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.
ER -