The long term clinical course of acute deep vein thrombosis of the arm: prospective cohort study
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.38167.684444.3A (Published 26 August 2004) Cite this as: BMJ 2004;329:484All rapid responses
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As a surgeon interested in thoracic outlet syndrome I treat many patients with effort related axillo-subclavian vein thrombosis (Paget- Schroetter Syndrome). 10% have presented with pulmonary embolus, so the condition can be quite dangerous. The difficulty is selecting those patients suitable for lysis and surgical decompression. In our practice we reserve this for those who want to continue with sport or music, on the understanding that anticoagulation alone carries a risk of 30-50% of venous hypertension in the future.
The authors include a separate category for exercise and thoracic outlet syndrome. Surely they are functionally (and often anatomically) the same entity?
Could the authors please tell us the specific long term outcomes for these two groups? I would find this very helpful.
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Dear Colleagues,
Thank you for your comments. We are very sorry for our mistake, due to the fact that we extracted our PTS score from that adopted for lower extremities, and forgot to suppress the word "pretibial".
Please accept our excuses
On behalf of my coworkers
Paolo Prandoni
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I understand that pretibial oedema was part of the standardised scale used in the follow up of patients with venous thrombosis of the leg. What was the equivalent used for patients with venous thrombosis of the arm?
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I read the article about the long term clinical course of acute deep vein thrombosis of the arm with interest but I wondered how pretibial oedema was related to thrombosis in the arm.
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Re: Paget Schroetter Syndrome
Dear colleague, thank you for your question. Of the three patients detected with the outlet thoracic syndrome, two developed their thrombotic episode following an unusual exercise. None was operated on. They were all treated with anticoagulants alone for three months, and their long-term outcome was as favourable as that observed in the remaining patients of our cohort. Of course, the number of patiens is too small to draw definite conclusions. With my kindest regards Paolo Prandoni
Competing interests: None declared
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