Thoracic outlet decompression for subclavian vein thrombosis: Experience in 71 Patients

Vasu Divi; Mary C Proctor; David A Axelrod; Lazar J Greenfield

doi:10.1001/archsurg.140.1.54

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Thoracic outlet decompression for subclavian vein thrombosis: Experience in 71 Patients

Journal article

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Peer reviewed

Thoracic outlet decompression for subclavian vein thrombosis: Experience in 71 Patients

Vasu Divi, Mary C Proctor, David A Axelrod and Lazar J Greenfield

Archives of surgery (Chicago. 1960), Vol.140(1), pp.54-57

2005

DOI: 10.1001/archsurg.140.1.54

PMID: 15655206

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Abstract

Hypothesis: There is a difference in outcomes when patients have neurogenic thoracic outlet syndrome in addition to subclavian vein thrombosis. Methods: Analysis of a prospectively developed database, medical record review, and a patient questionnaire were used to summarize clinical experience from December 1990 to December 2001 on the basis of the patient's original evaluation. Patients were stratified on the presence (group 1) or absence (group 2) of additional neurogenic pathologic features. Results: Of 928 patients evaluated for thoracic outlet syndrome, 71 underwent 73 operative procedures for subclavian vein obstruction. Men predominated (55%), and the mean age was 32 years. Group 1 (41%) had more preoperative disability, a higher incidence of persistent pain (24%), and less likelihood of returning to full activity compared with group 2 (67% vs 93%; P = .01). Catheter-directed thrombolysis was used in 65% of veins. Preoperative balloon angioplasty was used selectively (34%), and only 4% required stents. Supraclavicular decompression and venolysis were usually delayed 3 weeks to allow for healing of the venous endothelium. Complications included wound infection (3%) and postoperative hematoma (8%). Conclusions: Patients with isolated subclavian vein obstruction have a more favorable outcome relative to those with combined neurogenic and venous pathologic features. Decompression following thrombolysis should be delayed to reduce the incidence of postoperative complications.

Biological and medical sciences

Blood and lymphatic vessels

Cardiology. Vascular system

Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous

General aspects

Medical sciences

Details

Title: Subtitle: Thoracic outlet decompression for subclavian vein thrombosis: Experience in 71 Patients
Creators: Vasu Divi - University of Michigan
Mary C Proctor - University of Michigan
David A Axelrod - University of Michigan
Lazar J Greenfield - University of Michigan
Resource Type: Journal article
Publication Details: Archives of surgery (Chicago. 1960), Vol.140(1), pp.54-57
DOI: 10.1001/archsurg.140.1.54
PMID: 15655206
NLM abbreviation: Arch Surg
ISSN: 0004-0010
eISSN: 1538-3644
Publisher: American Medical Association
Language: English
Date published: 2005
Academic Unit: Surgery
Record Identifier: 9984322953702771

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