[Homolateral transposition of the internal jugular vein for axillo-subclavian venous thrombosis (of effort)].
Indications for treating subclavian vein obstruction are still being developed, especially for endovascular procedures with or without first rib resection. This article explores our experience with chronic and acute subclavian vein thrombosis persisting after medical treatment. In our department of vascular surgery, we have observed 2 cases of subclavian vein obstruction in 2 patients with Paget-Schroetler syndrome who developed major pain and edema in the dominant upper limb. Initially, we managed these patients medically with thrombolysis and anticoagulation. Then, as the significant symptoms persisted and venous thrombolysis developed, we decided on surgical treatment. Because of hypertrophic venous impairment, we used an aggressive procedure with venous bypass using jugular vein transposition and temporary arteriovenous fistula. We observed significant symptom relief and also perfect permeability of the venous bypass at 30 months.


CONCLUSIONS
On the basis of our anecdotal experience and reports by other groups, aggressive treatment with decompression (first rib resection and scalenectomy) and jugular vein transposition could be recommended for persistent subclavian vein thrombosis. Because of the presence of a thoraco-brachial outlet syndrome the endovascular procedures should be completed by first rib resection.
Ducasse
E
E
Service de Chirurgie Vasculaire, Hôpital Saint-Philibert, Lomme.
Habi
K
K
Espagne
P
P
Dujardin
C
C
Puppinck
P
P
D000328:Adult; D001365:Axilla / Q000098:blood supply*; D006801:Humans; D007601:Jugular Veins / Q000601:surgery*; D008297:Male; D013350:Subclavian Vein / Q000601:surgery*; D020246:Venous Thrombosis / Q000601:surgery*