Primary subclavian-axillary vein thrombosis: consensus and commentary.
Fifteen multiple-choice questions concerning options in the management of primary subclavian-axillary vein thrombosis were discussed by a panel of experts and then voted upon by 25 attending vascular surgeons with a special interest in venous disease and considerable experience in subclavian-axillary vein thrombosis. The large majority favored, or agreed upon: (1) early clot removal for active, healthy patients with a need/desire to use the involved limb in work or sport; (2) catheter-directed thrombolysis as initial therapy; (3) further therapy based on follow-up positional venography; (4) surgical relief of demonstrated thoracic outlet compression after a brief period of anticoagulant therapy; (5) conservative therapy if post-lysis venogram showed either (a) no extrinsic compression or (b) a short residual occlusion; and (6) intervention for residual intrinsic lesions with over 50% narrowing. However, there was little unanimity regarding the most appropriate intervention for residual stenoses, with opinion split between surgical and percutaneous transluminal angioplasty. For residual symptomatic occlusion 66% favored jugular vein turndown; only 10% would perform first rib removal.
Rutherford
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Section of Vascular Surgery, University of Colorado School of Medicine, Denver, USA.
Hurlbert
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D000800:Angioplasty, Balloon; D001367:Axillary Vein / Q000000981:diagnostic imaging; D006801:Humans; D010690:Phlebography; D013350:Subclavian Vein / Q000000981:diagnostic imaging; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome