Routine venography following transaxillary first rib resection and scalenectomy (FRRS) for chronic subclavian vein thrombosis ensures excellent outcomes and vein patency

Kevin Z. Chang, Kendall Likes, Jasmine Demos, James H. Black, Julie A. Freischlag

Research output: Contribution to journalArticle

23 Scopus citations


To assess the role of postoperative venography in patients treated with first rib resection and scalenectomy (FRRS) for effort thrombosis, a retrospective review was done to evaluate long-term venous patency in 84 patients treated at the Johns Hopkins Medical Institutions. Patients undergo venography 2 weeks postoperatively. If there is >50% stenosis, the subclavian vein is dilated and the patient receives anticoagulation. If the vein is occluded, patients are maintained on anticoagulation. Of the 85 patients, 21 patients had patent veins, 47 patients had stenotic veins, and 16 patients had chronically occluded veins. In follow-up, symptomatic restenosis was seen in 3 patients and those veins were redilated. Two other patients had late occlusions at 23 and 63 months and received anticoagulation and redilatation, respectively. Using venography to guide postoperative management, 79 of 84 patients had patent veins many years postoperatively. Long-term patency, as seen by duplex scan, was achieved in nearly all patients using this protocol.

Original languageEnglish (US)
Pages (from-to)15-20
Number of pages6
JournalVascular and Endovascular Surgery
Issue number1
StatePublished - Jan 2012
Externally publishedYes



  • effort thrombosis
  • first rib resection
  • Paget-Schroetter syndrome
  • thoracic outlet syndrome
  • venography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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