title: Effort subclavian vein thrombosis: evolution of management.
abstract: OBJECTIVE
  To analyze changes in the management of effort subclavian vein thrombosis at our institution.
  
  
  METHODS
  Records of 23 patients with effort subclavian vein thrombosis treated over a 10-year period were analyzed to compare the results of conventional therapy (heparin/warfarin) used in the first half of this period to a multimodality treatment strategy (thrombolysis and other adjunctive treatment as indicated, e.g., first rib resection, angioplasty/stenting, and vein reconstruction). Diagnostic testing included duplex ultrasound and venography. All patients had at least 1-year follow-up.
  
  
  RESULTS
  Eight patients (7 men; mean age 34 years, range 15-54) had conventional treatment (group A) and 15 patients (14 men; mean age 36 years, range 17-55) had multimodality therapy (group B). Demographics and clinical characteristics were comparable for both groups. Initial thrombolysis was achieved in 14 (93%) group B patients; 10 received adjunctive treatment to relieve external compression or vein stenosis. Four patients had successful first or cervical rib resection and scalenectomy, and first rib resection followed by angioplasty/stenting was successful in 2. However, angioplasty and stenting alone failed in 2 patients, while venous reconstruction was successful in only 1 of 2 cases. Mean follow-up was 72 months in group A patients and 59 months in group B. One (13%) group A patient and 12 (80%) group B patients demonstrated total venous recanalization and symptom resolution (p = 0.003). Overall, clinical resolution (total and partial symptom relief) was achieved in 3 (38%) group A patients and 13 (87%) group B patients (p = 0.026).
  
  
  CONCLUSIONS
  Initial lytic therapy followed by adjunctive treatment to relieve external venous compression or venous stenosis is effective in treating patients with effort subclavian vein thrombosis.
authors.affiliation: Department of Surgery, Charleston Area Medical Center, Robert C. Byrd Health Sciences Center of West Virginia University, Charleston, USA. ali.aburahma@camcare.com
authors.forename: A F
authors.initials: AF
authors.lastname: AbuRahma
authors.forename: P A
authors.initials: PA
authors.lastname: Robinson
mesh_terms: D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D002404:Catheterization; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D013350:Subclavian Vein; D015912:Thrombolytic Therapy; D020246:Venous Thrombosis / Q000601:surgery / Q000628:therapy*
chemical_list: D000925:Anticoagulants