Percutaneous thrombectomy in the management of early rethrombosis in venous thoracic outlet syndrome: two case reports

Ján Sýkora; Kamil Zeleňák; Martin Vorčák; Adam Krkoška; Štefánia Vetešková; Martina Sýkorová; Jozef Sivák; Ľuboš Hlinka; Igor Šinák

doi:10.1186/s42155-021-00250-6

Percutaneous thrombectomy in the management of early rethrombosis in venous thoracic outlet syndrome: two case reports

CVIR Endovasc. 2021 Aug 6;4(1):61. doi: 10.1186/s42155-021-00250-6.

Authors

Ján Sýkora¹, Kamil Zeleňák², Martin Vorčák¹, Adam Krkoška¹, Štefánia Vetešková¹, Martina Sýkorová³, Jozef Sivák⁴, Ľuboš Hlinka⁵, Igor Šinák⁵

Affiliations

¹ Clinic of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Kollárova 2, 036 59, Martin, Slovakia.
² Clinic of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Kollárova 2, 036 59, Martin, Slovakia. kamil.zelenak@uniba.sk.
³ Vaša ambulancia Ltd., Prieložtek 1, 036 01, Martin, Slovakia.
⁴ Middle-Slovak Institute of Cardiovascular Diseases, Cesta k nemocnici 1, 974 01, Banská Bystrica, Slovakia.
⁵ Department of Vascular Surgery, University Hospital, Kollárova 2, 036 59, Martin, Slovakia.

Abstract

Background: Venous thoracic outlet syndrome resulting in the upper limb deep venous thrombosis is known as Paget-Schroetter syndrome or effort thrombosis. A general treatment algorithm includes catheter-directed thrombolysis followed by surgical thoracic outlet decompression. There are limited data regarding endovascular treatment of rethrombosis presenting early after the surgery.

Case presentation: Two cases of early rethrombosis successfully treated with percutaneous mechanical thrombectomy by two different techniques are described. In both cases, rethrombosis was diagnosed soon after thrombolysis and first rib resection with scalenectomy. After 12 months, both patients remain symptom-free, with patent subclavian veins confirmed by duplex ultrasonography.

Conclusion: Percutaneous mechanical thrombectomy devices may offer a safe treatment option for patients with recurrent thrombosis after thoracic outlet surgery, even when thrombolytic therapy is contraindicated.

Keywords: Aspiration thrombectomy; Paget-Schroetter syndrome; Percutaneous mechanical thrombectomy; Upper extremity deep venous thrombosis; Venous thoracic outlet syndrome.