Limited venoplasty and anticoagulation affords excellent results after first rib resection and scalenectomy for subacute Paget-Schroetter syndrome

Objective: We have previously demonstrated excellent midterm patency rates following routine venography after first rib resection and scalenectomy (FRRS) for subacute Paget-Schroetter syndrome. The goal of this study was to assess the long-term outcomes of this technique. Methods: Retrospective analysis of a prospectively collected database was performed. Patients underwent routine venography 2 weeks post-FRRS. Warfarin was discontinued in those with patent veins. Patients with stenotic or occluded veins underwent attempted venoplasty with balloon diameters approximating the size of the anatomically normal vein. Patients with successful venoplasty or chronically occluded veins unable to be dilated were continued on warfarin up to 6 months. Follow-up duplex ultrasound dictated cessation of anticoagulation. Kaplan-Meier analysis was performed for primary, primary-assisted, and secondary patency. Results: A total of 159 patients underwent FRRS and postoperative venography with a median follow-up of 13.8 months. One patient was lost to follow-up. The median time to ERRS after the initial onset of symptoms was 4.1 months. At the time of venography, there were 42 patent, 72 stenotic, and 44 occluded veins. Of the 44 occlusions, 25 underwent venoplasty, and 19 could not be crossed. In the entire group, restenosis occurred in seven patients and reocdusion in seven. At last follow-up, six patients remained ocduded. Eighteen-month primary patency of venoplasty was 95.4% +/- 2.6% in the stenotic group and 75.6% +/- 8.7% in the ocduded group. Eighteen-month primary-assisted patency of venoplasty was 98.3% +/- 1.7% in the stenotic group and 96.0% +/- 3.9% in the occluded group. Overall secondary patency at 3 years was 100% in the patent group, 98.4% +/- 1.1.6% in the stenotic group, and 92.9% +/- 3.9% in the occluded group. Conclusions: Long-term venous patency rates after limited venoplasty and anticoagulation following FRRS are excellent. Furthermore, prolonged anticoagulation for ocdusions that could not be crossed or in those who reocclude after venoplasty results in recanalization and delayed patency. These results argue against the need for stenting or open venous reconstruction and serve as a benchmark for the care of patients with subacute Paget-Schroetter syndrome.