A Unified Approach to Axillosubclavian Venous Thrombosis in a Single Hospital Admission

Spontaneous or effort-related thrombosis of the axillosubclavian vein, termed Paget-Schroetter syndrome, is thought to be related to repetitive upper extremity physical activity, most commonly afflicting young, otherwise healthy, individuals. For the past 25 years, the mainstay of treatment for acute axillosubclavian venous thrombosis has consisted of early local catheter-directed thrombolytic therapy, an interval period of anticoagulation (3 months), and late surgical decompression of the thoracic outlet, with either a transaxillary or supraclavicular first rib resection. Immediate thrombolytic therapy followed by early surgical decompression has also been suggested previously, but has only recently been shown to be safe and efficacious, while significantly decreasing the duration of disability suffered by patients with this form of thoracic outlet syndrome. Therefore, a unified approach to acute axillosubclavian venous thrombosis in a single hospital admission should be considered an alternative standard of care for treatment of Paget-Schroetter syndrome.