静 脈 学 Table 1 Patient characteristics Symptom Case Age Sex Site PE Cause Treatment 1 44 M RSCV swelling (+) unknown UK, anticoaglant patent Result 2 5

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Paget-Schroetter 3 Paget-Schroetter 3 1 1 1 3 86 42 Paget-Schroetter 2013 24 1 71- Paget-Schroetter 3 Table 1 1 44 1 CT 1 2012 4 19 CT CT Fig. 1 2 54 CT Fig. 2 71

静 脈 学 Table 1 Patient characteristics Symptom Case Age Sex Site PE Cause Treatment 1 44 M RSCV swelling (+) unknown UK, anticoaglant patent Result 2 54 M LSCV swelling, numbness ( ) labor UK, anticoaglant stenosis 3 49 M LSCV swelling ( ) labor UK, anticoaglant occlusion A Fig. 1 B Case 1; Delayed phase CT. A: pre-treatment, B: post-treatment A B Fig. 2 Case 2; Venography. A: pre-treatment, B: post-treatment 72

Fig. 3 Case 3; Venography (past-treatment). 3 49 CT Fig. 3 4 11 Paget-Schroetter PSS 25 75 40 TOS 95 2 3 1 TOS PSS TOS costclavicular space TOS PSS PSS TOS TOS TOS CDT Hurlbert Rutherford 1 CDT 1 73

Table 2 Cases of surgical treatement collected from Japanese literature No Report year Auther Age Sex Day Operative procedure Outcome 1 1970 Murakami 20 M 0 Thrombectomy, Patch plasty Patent 2 1971 Ishii 40 M 1M Bypass Occlusion 3 1976 Okamoto 19 M 7 Rib resection, Thrombectomy Stenosis 4 19 Takahashi 25 M 13 Thrombectomy, Patch plasty Patent 5 19 Takahashi 26 M 0 Thrombectomy, Patch plasty Stenosis 6 1982 Sueda 46 M 10 Thrombectomy Patent 7 1983 Akao 38 M 1 Thrombectomy, Patch plasty Stenosis 8 1986 Ando 36 M 0 Thrombectomy Occlusion 9 1990 Matsuo 22 M 5 Thrombectomy Occlusion 10 1990 Matsuo 28 M 1 Thrombectomy, Patch plasty Occlusion 11 1993 Inasawa 23 M 2M Rib resection, Stent Patent 12 1996 Hanafusa 19 M 20 Rib resection, Bypass Occlusion 13 2001 Kawai 24 F 1M Rib resection Occlusion 14 2005 Aoyama 28 M 3M Ligation Occlusion 15 2006 Ejiri 16 M 3M Rib resection Stenosis 16 2007 Endo 17 M 1 Rib resection Patent 17 2008 Naito 22 M 1Y Rib resection Patent 18 2010 Yamakawa 37 M Rib resection, Patch plasty Stenosis 2 3 + 1 PSS 2 TOS 3 TOS 4 PTA stent 5 6 Molina 2 2 2 30 2 Emergency protocol 1 PSS CDT 2 3 8 4 2 cm PTA 5 3 20 cm 126 126 100 Molina PSS 86 42 42 18 3~18 10 3 + 5 74

Table 3 Cases of conservative treatment collected from Japanese literature No Report year Auther Age Sex Day Treatment Outcome 1 19 Takahashi 17 M 3 Thrombolysis Occlusion 2 19 Takahashi 71 M 4 Thrombolysis Patent 3 1979 Kamaya 47 M 12 Thromboyisis, Anticoagulation Occlusion 4 1980 Masuoka 36 M 6 Thrombolysis, Anticoagulation Patent 5 1982 Ri 19 M 20 Thrombolysis, Antiplateret Occlusion 6 1983 Imamura 17 M 3M Patent 7 1986 Kimura 34 F 6M Thrombolysis, Antiplateret Occlusion 8 1986 Nishiyama 19 F 0 Thrombolysis, Anticoagulation Occlusion 9 1990 Matsuo 67 M 12 Thrombolysis, Anticoagulation Occlusion 10 1993 Mukai 15 M 8 Thrombolysis Patent 11 1994 Futamura 21 M 7 Thrombolysis, Anticoagulation, Antiplateret Occlusion 12 1999 Oota 36 F 1M CDT, PTA, Filter Patent 13 1999 Odashiro 33 M 1 Thronbolysis, Anticoagulation Occlusion 14 1999 Odashiro 24 M 2 Thrombolysis, Anticoagulation Occlusion 15 2000 Shimizu 22 F 1 Thrombolysis, Anticoagulation Stenosis 16 2001 Taira 55 M 10 Thrombolysis, Anticoagulation Stenosis 17 2004 Kobayashi 39 M 1 Thrombolysis, Anticoagulation Occlusion 18 2005 Shimizu 60 M 14 CDT, PTA Patent 19 2006 Uchida 43 F 3 CDT, Anticoagulation Stenosis 20 2006 Uchida 16 M 1 CDT, Anticoagulation Stenosis 21 2008 Ichinose 64 M Thrombolysis, Filter Stenosis 22 2008 Mituha 30 M 2 Anticoagulation Occlusion 23 2009 Funatsu 50 M 7 CDT, PTA, Anticoagulation Patent 24 2011 Chiba 20 M 3 CDT, PTA, Anticoagulation Patent 1 1 8 1 1 1 1990 10 5 50 1990 8 6 75 Table 2 24 19~34 1999 10 1999 CDT 6 CDT 6 16 6 37.5CDT 6 6 100 Table 3 1990 TOS 1999 CDT TOS CDT Hurlbert Rutherford 1 CDT 2 3 75

TOS Molina 4 CDT TOS 2 PSS 3 PSS 1 Hurlbert SN, Rutherford RB: Subclavian-axillary vein thrombosis. Vascular Surgery. 5th Ed. Rutherford RB ed. Philadelphia, WB Saunders, 2000, pp. 1208-1219 2 Molina JE, Hunter DW, Dietz CA: Protocols for Paget- Schroetter syndrome and late treatment of chronic subclavian vein obstruction. Ann Thorac Surg 2009; 87: 416-422 3 1970; 25: 562-567 4 1 1971; XXX: 485-488 5 1976; 18: 821-824 6 19; 17: 627-633 7 Thrombectomy 1 1982; 35: 523-526 8 1983; 3: 92-96 9 Paget-Schroetter 1 1986; 48: 857-860 10 1990; 1: 69-73 11 Paget- Schroetter syndrome PTA 1 1993; 41: 1410-1414 12 Paget-Schroetter 3 1996; 7: 101-105 13 Paget-Schroetter 1 2002; 18: 910-912 14 Aoyama T, Suehiro S, Shibata T, et al: Paradoxical cerebral embolism in patient with Paget-Schroetter syndrome. Ann Thorac Cardiovasc Surg 2005; 11: 429-431 15 Paget-Schroetter 1 2006; 41: 829-833 16 1 2007; 18: 2-281 17 Paget-Schroetter 1 2008; 28: 796-780 18 Paget-Schroetter 1 2010; 19: 7-11 19 1 Med Postgrad 1979; 17: 540-544 20 2 Med Postgrad 1980; 18: 653-658 21 1 1982; 349-354 22 2 1983; 2: 52-54 23 Paget-Schroetter syndrome 1 76

29 1986; 47: 735-740 24 1 1986; 41: 1075-10 25 1 1993; 54: 1235-1239 26 1 1994; 55: 2148-2152 27 1 Ther Res 1999; 20: 1004-1007 28 Paget-Schroetter 2 1999; 52: 478-481 29 2000; 48: 313-316 30 2 2006; 17: 275-280 31 Paget-Schroetter 1 2008; 40: 806-811 32 Paget-Schroetter 1 Ther Res 2008; 28: 684-686 33 Paget-Schroetter Catheterdirected Thrombolysis CDT 1 2009; 24; 54-59 34 Paget-Schroetter 1 2011; 43: 896-890 Abstract Primary Subclavian Venous Thrombosis: Report of Three Cases and Review of the Japanese Literatures Shigeki Hirooka, Yoko Sotoda, Yuriko Kobayashi, and Hiroyuki Orita Department of Cardiovascular Surgery, Saiseikai Yamagata Saisei Hospital Key words: primary subclavian venous thrombosis, Paget-Schroetter syndrome, venous thoracic outlet syndrome Significant improvements were made in management of primary subclavian venous thrombosis due to venous thoracic outlet syndrome and unknown cause. The management according to the algorithm has become popular. We reviewed 86 cases from Japanese literatures and noticed that the aim of the management is recovery from symptoms in Japan although various treatments have been performed for patients. We treated three patients of primary subclavian venous thrombosis (Paget-Schroetter syndrome) with combined conservative therapy (thrombolysis and anticoagulant). All patients were relieved from symptoms and returned to social life without any complications. We constructed our protocol to treat Paget-Schroetter syndrome. Jpn J Phlebol 2013; 24 (1): 71-

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