A systematic review and meta-analysis for the management of Paget- Schroetter Syndrome.

ABSTRACT Objective There is currently no general agreement on the optimal treatment of Paget-Schroetter syndrome (PSS). Most centers have advocated an interventional approach that is based on results of small institutional series. The purpose of our meta-analysis was to focus on the safety and efficacy of thrombolysis or anticoagulation with decompression therapy. A detailed description of epidemiological, etiological and clinical characteristics, along with radiological findings and treatment option details was also performed. Methods The current meta-analysis was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies reporting on spontaneous thrombosis or thrombosis after strenuous activities of axillary-subclavian vein were considered eligible. Analyses of all retrospective studies were conducted, and pooled proportions with 95% confidence intervals (CIs) of outcome rates were calculated. Results Twenty-five studies with 1,511 patients were identified. Among these patients, 1,177 (77.9%) had thrombolysis, 658 (43.5%) had anticoagulation, whereas 1,293 (85.6%) patients had decompression therapy of the thoracic outlet. Complete thrombus resolution was estimated at 78.11% of the patients after thrombolysis, while the respective pooled proportion for partial resolution of thrombus was 23.72%. Despite thrombolytic therapy 212 patients underwent additional balloon angioplasty for residual stenosis while only 36 stents were implanted. After anticoagulation, a total of 40.70% of the patients had complete thrombus resolution whereas partial resolution was occurred in 29.13% of the patients. During follow-up, a total of 51.75% of the patients with any initial treatment modality had no remaining thrombus, while 84.87% of these patients were free of symptoms. We also estimated that 76.88% of the patients had “Disabilities of the Arm, Shoulder and Hand” (DASH) score Conclusions Although no randomized controlled data are available, our analysis strongly suggested higher rates of thrombus and symptoms resolution with thrombolysis, followed by first rib resection. A prospective randomized trial comparing anticoagulants with thrombolysis and decompression of thoracic outlet is required.