Initial experience with venous stents in exertional axillary-subclavian vein thrombosis

Purpose: Exertional thrombosis of the axillary and subclavian veins, also known as Paget-Schrotter syndrome, has been increasingly recognized in recent gears as a cause of long-term morbidity. Recent aggressive approaches to treating Paget-Schrotter syndrome have suggested the association of early failure with residual subclavian vein stenosis. As a result, the use of endoluminal stents has been proposed as an aid to venous percutaneous transluminal angioplasty for this disorder. Methods: This report outlines the therapy of II consecutive patients with Paget-Schrotter syndrome who were treated at our institution between October, 1992, and December, 1995. Stents were placed when percutaneous transluminal angioplasty was unsuccessful at achieving an adequate residual lumen. Results: Stents were placed after initial thrombolysis in six patients and in late follow-up in two patients. Of the six patients who had stents placed at initial thrombolysis, first-rib resection was eventually performed in four. In two patients first-rib resection was not performed, and stent fracture occurred in both. Late patency was achieved in the stents of six of the eight patients. Conclusions: Trials to evaluate stents as an adjunct to conventional therapy seem warranted. The use of stents alone without first-rib resection, however, appears to be associated with stent fracture.