The Turkish Journal of Vascular Surgery
Yazarlar: Nezihi KÜÇÜKARSLAN, Ertuğrul ÖZAL, Vedat YILDIRIM, Mehmet Ali ŞAHİN, Harun TATAR
Konular:-
Anahtar Kelimeler:Paget-Schrotter syndrome; thrombolytic therapy; rib resection
Özet: Pupose: To investigate the efficacy and adequacy of thrombolytic therapy and appropriate oral anticoagulation use in Paget- Schrotter syndrome without recommending surgical alternative. Methods: Fifty-two patients, treated with a diagnosis of Paget-Schrotter syndrome in the department of cardiovascular surgery during January 1996-April 2005, were retrospectively investigated through computer data and personal file recordings. All patients were assessed according to preoperative data, medical therapy, response to and complications of the therapy. Systemic heparin infusion (1000 I.U/h), t-PA (0,25 mg/kg, 1-2 h) given via brachial vein and if no relief in venous pain was obtained in 2-3 hours the infusion was continued up to 6-10 h with a dose of 0.05 mg/kg/h or systemic urokinase with a start dose of 500.000 IU and a maintenance dose of 50.000 IU/h was given and both were followed with oral anticoagulation. All patients were controlled in every three months by at least one of the three noninvasive methods; venous Doppler ultrasonography or venography during the following year. Results: Of the 52 treated patients, age distribution was 20-47 years, gender was 48 males (92.30%) and 4 females (7.69%). Thirty-eight patients (73.07%) had a history of employment with a physical arm power necessary job, and 31 patients (59.61%) were employed with a job needs physical arm power for over two hours. Nine patients (17.30%) had a past medical history of surgical procedure to the diseased extremity and 12 (23.07%) had trauma to that extremity. Twelve patients (23.07%) were obese, 25 patients (48.07%) were chronic cigarette smoker, 3 patients (5.76%) were alcoholic, 2 patients had malignancy (3.84%) and 4 patients (7.69%) had Paget-Schrotter syndrome at the affected extremity with neurological deficit. All patients were responded well to medical therapy, recurrence rate in the first month was 21.15% (11 patients) and mortality rate was 0%. Conclusion: Thrombolytic therapy and following oral anticoagulation for 6 months without recommending surgical approach is enough for the treatment of Paget-Schrotter syndrome. (Turkish J Vasc Surg 2006;15(2):17-21).