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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2012 December;25(6):437-9
Is sole medical treatment adequate in Paget-Schroetter syndrome?
Simsek E. 1, Teber M. A. 2, Katircioglu S. F. 1
1 Department of Cardiovascular Surgery, Etlik Ihtisas Training and Research Hospital, Ankara, Turkey;
2 Department of Radiology, Etlik Ihtisas Training and Research Hospital, Ankara, Turkey
The syndrome develops predominantly in young adults after repetitive difficult and exhausting exercises. It can be rarely observed. A 43-year-old man and a 46-year-old woman consulted to our clinic. They both couldn’t use their arms actively due to edema and severe pain in their arms and venous structures were distinctive in extremity. Axillary-subclavian vein thrombosis was detected in venous doppler ultrasonography. Before the patients were treated with low-molecule heparin for only ten days. We treated 20 days with low-molecule heparin and additionally, warfarin to hold INR between 2 and 3 was applied. After 4 months, it was detected that their venous system was totally recanalized. In upper extremities, profound venous thrombosis can be observed rarely and this includes 10% of all deep venous thrombosis. Many cases occur after difficult and exhausting exercises. Reoccurring micro traumas lead to thrombosis causing damage in the intima of the vein walls. Initial symptoms are ambiguous, not specific; therefore, the diagnosis is often delayed. Early diagnosis is important. Delayed diagnosis and inadequate treatment can be resulted in symptomatic and fatal pulmonary emboli. Both cases reminded us how much important this syndrome is. If the patient is young and the diagnosis can be achieved in early period, surgical treatment should come into prominence. We think that the initial low-molecule heparin application should continue at least 20 days. Surgical thrombectomy or stent application should be decided upon considering each patient appropriately. We want to highlight the significance of early diagnosis and adequate treatment because this syndrome is to threaten the life.