Treatment of axillosubclavian vein thrombosis: a novel technique for rapid removal of clot using low-dose thrombolysis.
OBJECTIVE
To report successful combined percutaneous mechanical thrombectomy and pharmacological lysis for axillosubclavian vein thrombosis, with rapid clot removal at a single setting using low-dose thrombolysis.


METHODS
Two consecutive patients presented with arm swelling; the diagnosis of axillosubclavian vein thrombosis was confirmed with duplex ultrasound. Both patients were treated percutaneously with the Solera mechanical thrombectomy device, after which 5 mg of tissue plasminogen activator were delivered within approximately 10 minutes via the Trellis infusion catheter to remove any residual thrombus. Completion venography and serial duplex ultrasound scans in follow-up demonstrated widely patent axillosubclavian veins with no residual thrombus in both cases.


CONCLUSIONS
Standard treatment of axillosubclavian vein thrombosis may require 12 to 36 hours, with multiple trips to the angiography suite. The novel technique combining mechanical thrombectomy and pharmacological lysis can be performed safely and successfully at a single setting with a small dose of the lytic drug.
Arko
Frank R
FR
Division of Vascular Surgery, Stanford University Medical Center, Stanford University, Stanford, California 94305, USA. farko@stanford.edu
Cipriano
Paul
P
Lee
Eugene
E
Filis
Konstantinos A
KA
Zarins
Christopher K
CK
Fogarty
Thomas J
TJ
D000328:Adult; D000368:Aged; D001367:Axillary Vein / Q000000981:diagnostic imaging; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D013350:Subclavian Vein / Q000000981:diagnostic imaging; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D018616:Ultrasonography, Doppler, Duplex; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*
D010959:Tissue Plasminogen Activator