Long term outcome following non- surgical management of Paget- Schroetter syndrome.

Abstract Objective Paget- Schroetter syndrome (PSS) is an uncommon disease, with potentially debilitating long term effects. The optimal therapy of PSS is unclear and the role of surgical decompression of the thoracic outlet is still being questioned. In this study we present long term results of patients treated with catheter directed thrombolysis (CDT) and anticoagulation, without undergoing surgical management. Methods This is a retrospective case series performed on all patients who previously underwent treatment for PSS in our institution between the years 2007-2019. Patients were evaluated for clinical signs of post thrombotic syndrome (PTS) using a modified Villata scoring scale, including measurements of the circumference of the treated and untreated arm. Ultrasound duplex of the treated vein was performed, and quality of life was evaluated using the QuickDASH (the Disability of the Arm Shoulder and Hand) questionnaire. Results Eighteen consecutive patients previously treated for PSS with CDT and anticoagulation comprise the cohort of this study. None underwent surgical thoracic outlet decompression. All were contacted and invited for clinical and ultrasonographic evaluation. Follow up was available for all patients. Mean age at diagnosis was 29 (range 16-46) and 15 (79%) were males. Mean time from the index event to the follow up clinic visit was 109 months (37-176). Patients were treated with anticoagulation for a mean period of 26 months (range 6-120). Seventeen patients (94%) had a Villata score of 0-3, consistent with nonexistence of PTS. Fourteen (78%) of the patients were completely asymptomatic. Seven patients (39%) had no difference in arm circumference. A difference in arm circumference between the treated arm and the healthy arm of 1 and 2 cm was seen in 9 (50%) and 2 (11%) patients, respectively. Based on the QuickDASH score, none of the patients suffered from impaired quality of life. Duplex scanning of the affected veins was performed on 16 of the 18 patients (89 %). The vein appeared patent in all examined patients. In 3 patients, the wall of the examined vein was thickened and irregular. Conclusions This study suggests that PSS patients can be treated with anticoagulation and CDT alone, without the need for surgical thoracic outlet decompression. This is based on long term follow up of these patients objectively evaluated by means of valid scoring systems. These findings suggest that they rarely develop symptoms or signs of PTS, do not suffer from impaired quality of life, and commonly maintain patency of the diseased vein.