| First rib resection and scalenectomy for chronically occluded subclavian veins: what does it really do? | |
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MedLine Citation:
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PMID: 18466817 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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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Authors:
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Ricardo de León; David C Chang; Christopher Busse; Diana Call; Julie Ann Freischlag |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Annals of vascular surgery Volume: 22 ISSN: 1615-5947 ISO Abbreviation: Ann Vasc Surg Publication Date: 2008 May-Jun |
Date Detail:
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Created Date: 2008-05-09 Completed Date: 2008-06-26 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8703941 Medline TA: Ann Vasc Surg Country: United States |
Other Details:
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Languages: eng Pagination: 395-401 Citation Subset: IM |
Affiliation:
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Division of Vascular Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Anticoagulants / therapeutic use Chronic Disease Female Humans Male Neck Muscles / surgery* Phlebography Ribs / surgery* Subclavian Vein / pathology, physiopathology, surgery* Tendons / surgery Thoracic Outlet Syndrome / etiology*, pathology, physiopathology, surgery Time Factors Treatment Outcome Ultrasonography, Doppler, Color Vascular Patency Venous Thrombosis / complications, pathology, physiopathology, surgery* Warfarin / therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 81-81-2/Warfarin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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