Document Detail

First rib resection and scalenectomy for chronically occluded subclavian veins: what does it really do?
MedLine Citation:
PMID:  18466817     Owner:  NLM     Status:  MEDLINE    
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.
Ricardo de León; David C Chang; Christopher Busse; Diana Call; Julie Ann Freischlag
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Annals of vascular surgery     Volume:  22     ISSN:  1615-5947     ISO Abbreviation:  Ann Vasc Surg     Publication Date:    2008 May-Jun
Date Detail:
Created Date:  2008-05-09     Completed Date:  2008-06-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8703941     Medline TA:  Ann Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  395-401     Citation Subset:  IM    
Division of Vascular Surgery, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21205, USA.
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MeSH Terms
Anticoagulants / therapeutic use
Chronic Disease
Neck Muscles / surgery*
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
Reg. No./Substance:
0/Anticoagulants; 81-81-2/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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