Outcomes following interval delayed first rib resection for acute axillosubclavian deep venous thrombosis.

BACKGROUND: Current management of axillosubclavian deep venous thrombosis (DVT) often uses thrombolysis for the DVT, prompt first rib removal, and occasional venoplasty or stenting. Our institution has increasingly used anticoagulation alone followed by interval first rib resection. We sought to analyze the effectiveness of this simplified technique. METHODS: Between September 2012 and April 2021, 27 patients were identified within the institution's electronic medical record as having undergone first rib resection for upper extremity DVT. Seven of these patients had undergone preoperative thrombolysis before referral and were excluded. Among the remaining 20 patients, preoperative clinic charts were evaluated for age, venous segment involvement, contralateral limb involvement, presence of documented hypercoagulable state, duration of preoperative and postoperative anticoagulation, and postoperative outcomes. RESULTS: Of the 20 patients (mean age, 26.2 years; 13 males) presenting with acute axillosubclavian DVT, all patients had right (n = 8) or left (n = 12) arm swelling. Five patients had extremity pain and four had extremity discoloration. Ten had axillosubclavian vein involvement, 9 had subclavian vein involvement, and 1 had axillary vein involvement. Two patients were on oral contraceptives and no patients had any other diagnosed hypercoagulable conditions. The mean duration of preoperative and postoperative anticoagulation was 3.2 ± 2.6 months and 2.1 ± 2.1 months, respectively. Nineteen patients underwent supraclavicular first rib resection and 1 patient underwent transaxillary resection. Twelve patients (60%) demonstrated complete DVT resolution by venous duplex examination during the postoperative period and 8 patients (40%) demonstrated partial recanalization/chronic DVT. Complications included one hemothorax and one thoracic duct injury. All 20 patients remain asymptomatic without arm swelling, with a mean follow-up of 55.1 ± 34.7 months. CONCLUSIONS: Among patients presenting with acute axillosubclavian DVT, anticoagulation alone followed by interval first rib resection proved to be successful in providing symptomatic relief in the short to medium term. By eliminating the need for preoperative thrombolysis and postoperative venograms, this potentially cost-saving algorithm simplifies our management for acute venous thoracic outlet syndrome while maintaining good clinical outcomes. Because this study only analyzed our management algorithm's effectiveness in the short to medium term, the long-term effectiveness of this treatment will need to be demonstrated.

[Translation into French and republication of: "Central venous catheter associated upper extremity deep vein thrombosis in cancer patients: Diagnosis and therapeutic management"]. / Traduction et republication de : « Thrombose veineuse profonde du membre supérieur associée à un cathéter veineux central chez les patients cancéreux : diagnostic et prise en charge thérapeutique ¼.

Catheter-related thrombosis (CRT) is a relatively frequent and potentially fatal complication arising in patients with cancer who require a central catheter placement for intravenous treatment. In everyday practice, CRT remains a challenge for management; despite its frequency and its negative clinical impact, few data are available concerning diagnosis and treatment of CRT. In particular, no diagnostic studies or clinical trials have been published that included exclusively patients with cancer and a central venous catheter (CVC). For this reason, many questions regarding optimal management of CRT remain unanswered. Due to the paucity of high-grade evidence regarding CRT in cancer patients, guidelines are derived from upper extremity DVT studies for diagnosis, and from those for lower limb DVT for treatment. This article addresses the issues of diagnosis and management of CRT through a review of the available literature and makes a number of proposals based on the available evidence. In symptomatic patients, venous ultrasound is the most appropriate choice for first-line diagnostic imaging of CRT because it is noninvasive, and its diagnostic performance is high (which is not the case in asymptomatic patients). In the absence of direct comparative clinical trials, we suggest treating patients with CRT with a therapeutic dose of either a LMWH or a direct oral factor Xa inhibitor, with or without a loading dose. These anticoagulants should be given for a total of at least 3 months, including at least 1 month after catheter removal following initiation of therapy.

Lesiones vasculares asociadas a la práctica del pádel. El síndrome de Paget-Schroetter / Vascular lesions associated with the padel practice. Paget-Schroetter síndrome

INTRODUCCIÓN: El pádel es un joven deporte que atrae a millones de personas, de ambos sexos, de todas las edades y condición social. Practicarlo aporta numerosos beneficios para la salud, pero también puede inducir lesiones. OBJETIVOS: Analizar la relación patología vascular y pádel, y presentar los aspectos más significativos del síndrome de Paget-Schroetter, y relacionarlos con dicho deporte. METODOLOGÍA: Se realiza una revisión de la literatura, hasta el 1 de agosto del 2019, en PubMed, Google y revistas españolas especializadas; conjuntamente presentamos un caso clínico. RESULTADOS: La búsqueda realizada no encontró ninguna referencia entre pádel y patología vascular, pero identificó 20 artículos que relacionan deportes de raqueta y patología vascular, que nos permite inferir algunos de sus aspectos al pádel. CASO CLÍNICO: Varón de 34 años, practicante habitual de pádel, diagnosticado mediante eco-Doppler de una trombosis venosa axilo-subclavia derecha (síndrome de Paget-Schroetter); fue tratado satisfactoriamente mediante fibrinolisis local, a través de catéter, y posterior resección de la primera costilla (toracoscopia). Actualmente está asintomático y bajo anticoagulación oral. CONCLUSIONES: 1) Escasa bibliografía al respecto; 2) Baja frecuencia de complicaciones vasculares durante la práctica de los deportes con raqueta; y 3) Primer caso de la literatura, de un síndrome de Paget-Schroetter asociado al pádel. Consecuencias prácticas: 1) El mecanismo de producción se explica por la combinación de factores desencadenantes (repetición de movimientos del hombro, asociados a posiciones forzadas - abducción del brazo), y predisponentes (compresión venosa por estructuras anatómicas anómalas); y 2) Pensar en esta entidad, fundamentalmente ante jóvenes, deportistas, y sin antecedentes patológicos; únicamente un manejo precoz evita complicaciones (embolia pulmonar), recidivas y secuelas (síndrome postrombótico)

INTRODUCTION: Padel is a young sport that attracts millions of people, of both sex, all ages and social status. Practicing padel brings numerous health benefits, but it can also induce injuries. OBJECTIVES: To analyze the relationship between vascular and padel pathology, and present the most significant aspects of Paget-Schroetter syndrome, and relate them to padel. METHODOLOGY: Literature review, until August 1, 2019, in PubMed, Google and specialized Spanish journals; and presentation of a clinical case. RESULTS: The search did not find any reference between padel and vascular pathology, but I identify 20 articles that relate racket sports and vascular pathology, to infer some of its aspects to padel. Clinical case: A 34-year-old male, a regular padel practitioner, diagnosed (echo-Doppler) with a right axillary subclavian venous thrombosis (Paget-Schroetter syndrome); satisfactorily treated by local fibrinolysis (through catheter) and resection of the first rib (thoracoscopy). Currently asymptomatic and under oral anticoagulation. CONCLUSIONS: 1) Little bibliography in this regard; 2) Low frequency of vascular complications during racquet sports; and 3) First case of the literature, of a Paget-Schoetter syndrome associated with padel player. Practical consequences: 1) The mechanism of production is explained by the combination of triggers (repetition of shoulder movements, associated with forced positions - abduction of the arm), and predisposing factors (venous compression by anomalous anatomical structures); and 2) Think of this entity, mainly before young people, athletes, and without a pathological history; only early management prevents complications (pulmonary embolism), relapses and sequelae (post-thrombotic syndrome)

Tratamiento multidisciplinario actual por etapas del síndrome de Paget-Schroetter: a propósito de 2 casos y revisión de la literatura / Current multidisciplinary treatment by stages of the Paget-Schroetter syndrome: in relation to 2 cases and review of the literatura

El síndrome de opérculo torácico se debe a la compresión de los vasos subclavios y/o plexo braquial. Puede ser de tipo neurológico (95%), venoso (< 4%) y arterial (1%). Se conoce como síndrome de Paget-Schroetter al síndrome de opérculo torácico que se asocia a trombosis de la vena subclavia, más común en la extremidad superior dominante y en pacientes jóvenes. El tratamiento de elección para el síndrome de Paget-Schroetter consiste en la trombólisis de la vena subclavia y en la resección de la primera costilla de forma temprana para descomprimir el paquete neurovascular subclavio, disminuyendo el riesgo de retrombosis o síntomas recurrentes. En este artículo describimos dos casos de tratamiento para el síndrome de Paget-Schroetter con resección por cirugía toracoscópica video asistida de la primera costilla y realizamos una revisión de la literatura al respecto

The thoracic outlet compression is due to the compression of the subclavian vessels and / or brachial plexus, which can be neurological (95%), venous (< 4%) and arterial (1%). Paget-Schroetter syndrome is when thoracic outlet compression is associated with subclavian vein thrombosis, being more common in the dominant upper limb and in young patients. The treatment of choice for Paget-Schroetter syndrome consists of thrombolysis of the subclavian vein and resection of the first rib early, to decompress the subclavian neurovascular bundle, decreasing the risk of rethrombosis or recurrent symptoms. In this article, we describe 2 cases of treatment for Paget-Schroetter syndrome with video-Assisted Thoracoscopic Surgery resection of the first rib, carrying out a review of the literature in this regard

Trombosis venosa profunda de miembros superiores asociada a dispositivos intravasculares serie de casos / Deep vein thrombosis of the upper limbs associated with intravascular devices number of cases

El 10% de todos los casos de trombosis venosa profunda afectan a las extremidades superiores. La trombosis venosa profunda de los miembros superiores (TVPMS) es una entidad cada vez más frecuente debido al uso de catéteres venosos centrales (CVC) y de dispositivos transvenosos, como marcapasos y cardiodesfibriladores. Las venas más frecuentemente involucradas son la subclavia y la axilar.

10% of all cases of deep vein thrombosis affect the upper extremities. Deep vein thrombosis of the upper limbs (DVTUL) is an increasingly common entity due to the use of central venous catheters (CVC) and transvenous devices, such as pacemakers and cardio-defibrillators. The most frequently involved veins are the subclavian and the axillary.

Trombosis venosa profunda primaria de miembro superior / Primary lower-limb deep venous thrombosis

No disponible

Trombolisis local dirigida en una trombosis venosa profunda del miembro superior / Catheter-directed thrombolysis in upper-extremity deep vein thrombosis

No disponible

Síndrome de Paget-Schroetter: a favor del tratamiento médico / No disponible

No disponible

Manejo multidisciplinar del síndrome de Paget-Schroetter. A propósito de una serie de 8 casos / Multidisciplinary management of Paget-Schroetter Syndrome. A case series of eight patients

El síndrome de Paget-Schroetter (SPS) en el contexto de trombosis venosa profunda (TVP) de miembro superior es una patología poco frecuente pero de gran importancia por afectar personas sanas y jóvenes, donde el síndrome postrombótico (SPT) secundario puede ser una complicación con importantes implicaciones. La mejor opción de tratamiento es controvertida. Las guías actuales recomiendan anticoagulación durante un mínimo de 3 meses, aunque se han visto con este manejo incidencias de SPT cercanas al 50% a los 6 meses, al 30% al año y al 25% a los 2 años, por lo que unidades especializadas abogan por la realización de trombólisis local y cirugía descompresiva precoz, con el propósito de disminuir estas cifras. Describimos una serie de 8 casos, a los que tratamos de esta última manera. Ningún paciente presentó complicaciones, y en todos se observó reintegro precoz a la actividad diaria, con ausencia de SPT en el 90% de ellos

Paget-Schroetter syndrome (PSS) in the context of upper extremity deep venous thrombosis (DVT) is an uncommon but potentially very serious condition affecting young, healthy adults, in which secondary post-thrombotic syndrome (PTS) can be a complication with major implications. The best treatment option remains controversial, with current guidelines recommending anticoagulation for at least 3 months. However, an incidence of PTS of approximately 50% after 6 months, 30% after 1 year and 25% after 2 years has been found using this therapeutic approach. Consequently, specialized units recommend local thrombolysis and early decompressive surgery. We describe a series of eight cases treated in this way. None of the patients showed signs of complications, and an early return to regular activities with no PTS was observed in 90% of cases

Trombose venosa subclávio-axilar (Síndrome de Paget-Schroetter) / Subclavian-axillary vein thrombosis (paget-Schroetter syndrome)

A trombose venosa subclávio-axilar é um evento trombótico pouco frequente, relacionado a esforço físico excessivo com o membro superior dominante. Ocorre predominantemente em indivíduos jovens do sexo masculino, e apresenta-se com quadro agudo de trombose venosa profunda, devendo ser lembrada no diagnóstico diferencial de patologias que causam dor e edema em membro superior. O diagnóstico e a terapêutica precoces têm fundamental importância para minimizar a morbidade desta condição

The axillary-subclavian vein thrombosis is an infrequent thrombotic event, related to excessive physical effort with the dominant upper extremity. It happens predominantly in young men and appears as deep vein thrombosis that must be reminded on the differential diagnosis of pathologies that cause pain and swelling in the upper extremity. The early diagnosis and therapy have great importance to minimize the morbidity of this condition