| Surgical intervention is not required for all patients with subclavian vein thrombosis. | |
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MedLine Citation:
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PMID: 10876207 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: The role of thoracic outlet decompression in the treatment of primary axillary-subclavian vein thrombosis remains controversial. The timing and indications for surgery are not well defined, and thoracic outlet procedures may be associated with infrequent, but significant, morbidity. We examined the outcomes of patients treated with or without surgery after the results of initial thrombolytic therapy and a short period of outpatient anticoagulation. METHODS: Patients suspected of having a primary deep venous thrombosis underwent an urgent color-flow venous duplex ultrasound scan, followed by a venogram and catheter-directed thrombolysis. They were then converted from heparin to outpatient warfarin. Patients who remained asymptomatic received anticoagulants for 3 months. Patients who, at 4 weeks, had persistent symptoms of venous hypertension and positional obstruction of the subclavian vein, venous collaterals, or both demonstrated by means of venogram underwent thoracic outlet decompression and postoperative anticoagulation for 1 month. RESULTS: Twenty-two patients were treated between June 1996 and June 1999. Of the 18 patients who received catheter-directed thrombolysis, complete patency was achieved in eight patients (44%), and partial patency was achieved in the remaining 10 patients (56%). Nine of 22 patients (41%) did not require surgery, and the remaining 13 patients underwent thoracic outlet decompression through a supraclavicular approach with scalenectomy, first-rib resection, and venolysis. Recurrent thrombosis developed in only one patient during the immediate period of anticoagulation. Eleven of 13 patients (85%) treated with surgery and eight of nine patients (89%) treated without surgery sustained durable relief of their symptoms and a return to their baseline level of physical activity. All patients who underwent surgery maintained their venous patency on follow-up duplex scanning imaging. CONCLUSION: Not all patients with primary axillary-subclavian vein thrombosis require surgical intervention. A period of observation while patients are receiving oral anticoagulation for at least 1 month allows the selection of patients who will do well with nonoperative therapy. Patients with persistent symptoms and venous obstruction should be offered thoracic outlet decompression. Chronic anticoagulation is not required in these patients. |
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Authors:
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W A Lee; B B Hill; E J Harris; C P Semba; I V Olcott C |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of vascular surgery Volume: 32 ISSN: 0741-5214 ISO Abbreviation: J. Vasc. Surg. Publication Date: 2000 Jul |
Date Detail:
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Created Date: 2000-08-02 Completed Date: 2000-08-02 Revised Date: 2012-10-03 |
Medline Journal Info:
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Nlm Unique ID: 8407742 Medline TA: J Vasc Surg Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 57-67 Citation Subset: IM |
Affiliation:
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Divisions of Vascular Surgery and Interventional Cardiovascular Radiology, Stanford University School of Medicine, Stanford, CA 94305-5642, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Axillary Vein Female Humans Male Middle Aged Subclavian Vein* Thrombolytic Therapy Treatment Outcome Vascular Patency Vascular Surgical Procedures Venous Thrombosis / drug therapy, surgery* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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