Abstract
First rib resection and scalenectomy is an acceptable therapy for those with axillosubclavian vein thrombosis who have responded to lytic therapy and demonstrated subclavian vein patency. However, the treatment for those patients who present with a chronically occluded subclavian vein is controversial. We present four such patients who underwent first rib resection and scalenectomy and whose subclavian vein spontaneously opened within the first year following surgery while anticoagulated, as well as the ultrasound protocol we employ at our institution to identify such reopening. The average age of these patients was 20 (range 17-23) years; three were male and one was female. The average time interval prior to surgery when the initial thrombosis occurred was 25 (12-34) weeks. All patients were symptomatic and underwent a transaxillary first rib resection and scalenectomy with attention to incise the subclavius tendon. All were maintained on warfarin postoperatively and surveilled by duplex scan. In all four patients the subclavian vein subsequently opened after an average of 7 (2-11) months and anticoagulation was stopped. The resultant patent subclavian vein correlated with improvement in symptoms in all four patients. All patients were asymptomatic in the postoperative follow-up period at an average of 14 (2-33 months). In conclusion, selective symptomatic patients with subclavian vein occlusion can be aggressively treated with first rib resection and scalenectomy along with anticoagulation that will lead to recanalization and opening of vein over time. This treatment correlates with improvement of their symptoms.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 395-401 |
| Number of pages | 7 |
| Journal | Annals of Vascular Surgery |
| Volume | 22 |
| Issue number | 3 |
| DOIs | |
| State | Published - May 2008 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
First Rib Resection and Scalenectomy for Chronically Occluded Subclavian Veins : What Does It Really Do? / de León, Ricardo; Chang, David C.; Busse, Christopher; Call, Diana; Freischlag, Julie Ann.
In: Annals of Vascular Surgery, Vol. 22, No. 3, 05.2008, p. 395-401.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - First Rib Resection and Scalenectomy for Chronically Occluded Subclavian Veins
T2 - What Does It Really Do?
AU - de León, Ricardo
AU - Chang, David C.
AU - Busse, Christopher
AU - Call, Diana
AU - Freischlag, Julie Ann
PY - 2008/5
Y1 - 2008/5
N2 - First rib resection and scalenectomy is an acceptable therapy for those with axillosubclavian vein thrombosis who have responded to lytic therapy and demonstrated subclavian vein patency. However, the treatment for those patients who present with a chronically occluded subclavian vein is controversial. We present four such patients who underwent first rib resection and scalenectomy and whose subclavian vein spontaneously opened within the first year following surgery while anticoagulated, as well as the ultrasound protocol we employ at our institution to identify such reopening. The average age of these patients was 20 (range 17-23) years; three were male and one was female. The average time interval prior to surgery when the initial thrombosis occurred was 25 (12-34) weeks. All patients were symptomatic and underwent a transaxillary first rib resection and scalenectomy with attention to incise the subclavius tendon. All were maintained on warfarin postoperatively and surveilled by duplex scan. In all four patients the subclavian vein subsequently opened after an average of 7 (2-11) months and anticoagulation was stopped. The resultant patent subclavian vein correlated with improvement in symptoms in all four patients. All patients were asymptomatic in the postoperative follow-up period at an average of 14 (2-33 months). In conclusion, selective symptomatic patients with subclavian vein occlusion can be aggressively treated with first rib resection and scalenectomy along with anticoagulation that will lead to recanalization and opening of vein over time. This treatment correlates with improvement of their symptoms.
AB - First rib resection and scalenectomy is an acceptable therapy for those with axillosubclavian vein thrombosis who have responded to lytic therapy and demonstrated subclavian vein patency. However, the treatment for those patients who present with a chronically occluded subclavian vein is controversial. We present four such patients who underwent first rib resection and scalenectomy and whose subclavian vein spontaneously opened within the first year following surgery while anticoagulated, as well as the ultrasound protocol we employ at our institution to identify such reopening. The average age of these patients was 20 (range 17-23) years; three were male and one was female. The average time interval prior to surgery when the initial thrombosis occurred was 25 (12-34) weeks. All patients were symptomatic and underwent a transaxillary first rib resection and scalenectomy with attention to incise the subclavius tendon. All were maintained on warfarin postoperatively and surveilled by duplex scan. In all four patients the subclavian vein subsequently opened after an average of 7 (2-11) months and anticoagulation was stopped. The resultant patent subclavian vein correlated with improvement in symptoms in all four patients. All patients were asymptomatic in the postoperative follow-up period at an average of 14 (2-33 months). In conclusion, selective symptomatic patients with subclavian vein occlusion can be aggressively treated with first rib resection and scalenectomy along with anticoagulation that will lead to recanalization and opening of vein over time. This treatment correlates with improvement of their symptoms.
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UR - http://www.scopus.com/inward/citedby.url?scp=42949157823&partnerID=8YFLogxK
U2 - 10.1016/j.avsg.2007.12.020
DO - 10.1016/j.avsg.2007.12.020
M3 - Article
VL - 22
SP - 395
EP - 401
JO - Annals of Vascular Surgery
JF - Annals of Vascular Surgery
SN - 0890-5096
IS - 3
ER -