Surgical management of subclavian vein obstruction, including six cases of subclavian vein bypass.
BACKGROUND
The indications are still being developed for the various procedures available to treat thrombotic and nonthrombotic subclavian vein obstruction. This article explores our experience with the surgical options, primarily with chronic venous occlusion, but also with acute thrombosis.


METHODS
Twelve patients presented with acute or chronic venous thrombosis or nonthrombotic venous obstruction. Treatment included thrombolysis, vein patch angioplasty, thrombectomy, first rib resection, venolysis, and/or subclavian vein bypass by either jugular vein transposition or prosthetic axillojugular bypass.


RESULTS
Six patients experienced relief of all symptoms; the other six have had relief from pain but continue to have occasional swelling.


CONCLUSIONS
On the basis of our anecdotal experiences and those of others, the following protocol has been developed. After acute thrombosis, lytic therapy is recommended. If successful, first rib resection and venolysis should be considered; if unsuccessful and the patient has significant symptoms, immediate thrombectomy is indicated. If patency is established, rib resection and venolysis should follow. Persistent stenosis is treated by angioplasty, either with a vein patch or percutaneously. Complete occlusion is managed by jugular vein transposition or axillojugular bypass. Temporary arteriovenous fistulas accompany all open venous repairs.
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012272:Ribs / Q000601:surgery; D013350:Subclavian Vein / Q000601:surgery*; D013927:Thrombosis / Q000601:surgery*