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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2014 Apr 17

language: English

Long-term functional outcomes and subclavian veinpatency in patients undergoing thoracic outlet surgery for Paget-Schroetter syndrome

Jean-Baptiste E.1, 2, Sadaghianloo N. 1, 2, Mousnier A. 1, 2, Brizzi S. 1, 2, Declemy S. 1,2, Hassen-Khodja R. 1, 2

1 University of NiceSophiaAntipolis, Graduate School of Medicine, Nice, France;
2 Department of Vascular Surgery, Saint Roch Hospital, CHU de Nice, France


OBJECTIVES: To assess subclavian vein (SCV) patency and long-term functional outcomes following surgical decompression of the thoracic outlet (SDTO) for Paget-Schroetter syndrome (PSS).
MATERIALS AND METHODS: Between January 1978 and January 2013, we identified 33 patients with PSS who underwent SDTO. Demographic, clinical and radiological data were extracted from electronic databases and patient records. All patients were invited to update their follow-up data during dedicated outpatient visits between October and December 2013. Outcome measures included long-term SCV patency and clinical success rates during follow-up. Clinical success was defined as the combined absence of functional symptoms and patient's ability to maintain normal professional activities at final follow-up. The QuickDASH score was also determined.
RESULTS: The study population comprised 17 men and 16 women (mean age: 34 yrs; range: 1453yrs) with PSS. Diagnosis was reached by venography (29 cases) or duplex scan (4 cases). SDTO was performed via the transaxillary route (25 cases) or using the combined supra-infraclavicular approach (8 cases). The procedure was carried out within 10 days in 13 patients (early-group),and between 30 to 120 days in the remaining 20 patients (late-group). The former had SCV recanalisation obtained actively by thrombolysis (3 cases), thrombectomy (9 cases) or endovenectomy followed by patch venoplasty (1 case). The latter were maintained under chronic oral anticoagulation to allow SCV recanalisation. There was neither postoperative death nor major bleeding complications. At a median follow-up of 240 months, 11 SCV remained patent in the early group, while in the other there was 3 reocclusions, 4 residual stenoses and 5 chronic SCV occlusions. Clinical success was achieved in 73% of patients for the whole cohort, but was significantly better in patients operated on in the early stages (100%vs.55%; P=0.005). The mean QuickDASH score was 3.5[95%CI:1.5-5.4] in the early-group and 17.3[95%CI: 8.4-26.2] in the late-group(P=0.01).
CONCLUSIONS: Our data shows that long-term functional outcomes and SCV patency remained better in PSS patients who underwent early SDTO and active SCV recanalisation techniques.

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