Thoracic outlet decompression for subclavian vein thrombosis: experience in 71 patients.
OBJECTIVE
There is a difference in outcomes when patients have neurogenic thoracic outlet syndrome in addition to subclavian vein thrombosis.


METHODS
Analysis of a prospectively developed database, medical record review, and a patient questionnaire were used to summarize clinical experience from December 1990 to December 2001 on the basis of the patient's original evaluation. Patients were stratified on the presence (group 1) or absence (group 2) of additional neurogenic pathologic features.


RESULTS
Of 928 patients evaluated for thoracic outlet syndrome, 71 underwent 73 operative procedures for subclavian vein obstruction. Men predominated (55%), and the mean age was 32 years. Group 1 (41%) had more preoperative disability, a higher incidence of persistent pain (24%), and less likelihood of returning to full activity compared with group 2 (67% vs 93%; P = .01). Catheter-directed thrombolysis was used in 65% of veins. Preoperative balloon angioplasty was used selectively (34%), and only 4% required stents. Supraclavicular decompression and venolysis were usually delayed 3 weeks to allow for healing of the venous endothelium. Complications included wound infection (3%) and postoperative hematoma (8%).


CONCLUSIONS
Patients with isolated subclavian vein obstruction have a more favorable outcome relative to those with combined neurogenic and venous pathologic features. Decompression following thrombolysis should be delayed to reduce the incidence of postoperative complications.
Divi
Vasu
V
Department of Surgery, University of Michigan, Ann Arbor 48105, USA.
Proctor
Mary C
MC
Axelrod
David A
DA
Greenfield
Lazar J
LJ
D000328:Adult; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D012737:Sex Factors; D013350:Subclavian Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D013901:Thoracic Outlet Syndrome / Q000150:complications* / Q000601:surgery; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D020246:Venous Thrombosis / Q000150:complications*