Management of subclavian-axillary vein thrombosis: a review.

OBJECTIVE To study, by literature review, the management of subclavian-axillary vein thrombosis (SAVT) and to make recommendations. DATA SOURCES The MEDLINE database and cross-referenced articles. STUDY SELECTION Key words subclavian-axillary vein thrombosis, venous thrombosis, Paget-Schroetter syndrome, anticoagulation, and thrombolysis were used to extract articles related to SAVT. DATA EXTRACTION Independent extraction of articles by 2 observers. DATA SYNTHESIS Although numerous studies are available in the literature, they vary widely in their patient selection, treatment methods, follow-up and conclusions. As such, the management of patients with SAVT remains controversial. CONCLUSIONS Anticoagulation remains the initial treatment of choice for acute SAVT although there is definitely a role for thrombolysis and surgery in selected cases. Surgical intervention should be reserved for patients in whom there is a specific indication. Since chronic symptoms depend largely on the etiology of the disease, treatment should be tailored to address the causative factors. A multicentre, prospective study is necessary to evaluate the optimum management strategies for patients with SAVT.