Endovascular treatment of acute upper extremity deep vein thrombosis in Paget-Schroetter syndrome: A longitudinal analysis of three endovascular techniques.

OBJECTIVE

Optimal procedural strategies for the management of acute upper extremity deep vein thrombosis (UEDVT) due to Paget-Schroetter syndrome are poorly studied due to its rarity. The aim of this study was to compare short-term patency, complication rates, and course after endovascular therapy of acute UEDVT due to Paget-Schroetter syndrome.

METHODS

In this single-center retrospective longitudinal study, data of consecutive patients with acute Paget-Schroetter syndrome treated with interventional thrombectomy at the University Hospital Zurich with any available device: computer assisted vacuum thrombectomy (CAVT), AngioJet/Zelante catheter, or catheter-directed thrombolysis (CDT) was collected. We studied the need for reintervention, primary and secondary patency, and course of symptoms at 2 weeks, 3 months, and 6 months.

RESULTS

We included 41 patients with acute UEDVT treated between 2017 and 2025. The median age was 34 years; 61% were men, and 41% were athletes. After a median symptom duration of 4 days, they received thrombectomy with AngioJet/Zelante (61%), CAVT (17%), and CDT (22%). Sixteen patients (39%) required reintervention, mostly within 48 hours (62.5%). Primary patency was 60% (24/40) at 2 weeks, 52.6% (20/38) at 3 months, and 54.1% (20/37) at 6 months (P = .08 for between-group difference). Secondary patency was 72%, 76%, and 86%, respectively. Kaplan-Meier analysis showed higher freedom from reintervention after CAVT (P = .04). Symptom relief occurred mainly within the first 2 weeks: swelling (98% to 17%), pain (60% to 14%). Cyanosis resolved by 6 months, whereas paresthesia slightly increased (15% to 23%). Only one major and one minor bleeding event occurred.

CONCLUSIONS

Catheter-directed therapies appeared to be safe and effective for UEDVT due to Paget-Schroetter syndrome. In this exploratory study, bearing the small sample size, the data suggest that single-session thrombectomy (especially CAVT) may be associated with fewer reinterventions and higher primary patency.