Abstract

Introduction Primary subclavian vein thrombosis (PSVT) is a rare (2/100,000 per year) disorder, affecting mostly young, active and otherwise healthy individuals. Untreated it can lead to post thrombotic syndrome (PTS) which leaves the patient with a chronic impairment of the arm. Several treatment strategies have been suggested to avoid PTS: immediate thrombolysis and decompressive surgery, delayed decompressive surgery or treatment with anticoagulation alone. Studies show conflicting results, and there is scarce evidence regarding which strategy to prefer.

Aim To investigate whether early invasive treatment with thrombolysis and decompressive surgery in patients with PSVT, is associated with improved quality of life compared to delayed decompressive surgery or treatment with anticoagulation alone.

Material and methods Quality of life was evaluated in 87 patients treated for PSVT in Stockholm during 2008-2017. Treatment with immediate thrombolysis and surgery (acute group, n=46) was compared to treatment with delayed surgery (chronic group, n=20), and with anticoagulation alone (conservative group, n=21). The patients answered a disease-specific quality of life instrument (Disabilities of the arm, shoulder and hand, DASH) before and after intervention. One-way ANOVA and Post-hoc test was used to identify differences in DASH-score between the treatment groups. A multivariate regression model was used to adjust for potential confounders.

Results The acute group had superior outcome with lower DASH-score compared to the chronic group after intervention (p=.006), and compared to the chronic group and conservative group together (p=.0002). No confounders were found.

Conclusions Treatment of PSVT with immediate thrombolysis and surgery was related to superior results compared to delayed treatment. Because of the retrospective study design, more research is needed to clarify if causation is present.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This study did not receive any funding

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Regional Ethics Committe of Stockholm County (Regionala Etikprovningsnaemnden i Stockholm) gave ethical approval for this work (Diary number 2016/2484-31/2)

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Data Availability

Data will be shared for individual-participant-data meta-analysis with other members of the research community who have an affiliation to a recognised medical university. Data will only be shared with investigator support, after approval of a proposal, and with a signed data access agreement. Additional restrictions will apply in accordance with Swedish law.

AbbreviationsCDTCatheter-directed thrombolysisCRFCase report formCTComputed tomographyCVCCentral venous catheterDASHThe disabilities of the arm, shoulder and handDVTDeep venous thrombosisEQ-5DEuroQol five dimensionsMRIMagnetic resonance imagingPEPulmonary embolismPSVTPrimary subclavian vein thrombosisPTSPost-thrombotic syndromeQoLQuality of lifeUEDVTUpper extremity deep venous thrombosisVKAVitamin K antagonistV-TOSVenous thoracic outlet syndrome