title: Aggressive treatment of idiopathic axillo-subclavian vein thrombosis provides excellent long-term function.
abstract: OBJECTIVE
  While much attention has been devoted toward treatment paradigms for idiopathic axillo-subclavian vein thrombosis (ASVT), little has focused on long-term durability of aggressive treatment and its associated functional outcomes. The purpose of this study was to review our own surgical therapeutic algorithm and its associated durability and functional outcomes.
  
  
  METHODS
  All patients treated with combined endovascular and open surgery at Dartmouth-Hitchcock Medical Center for ASVT from 1988 to 2008 were identified. Patient demographics, comorbidities, and operative techniques were recorded. Patency, freedom from reintervention, and functional outcomes were documented. Follow-up via telephone and clinic visit allowed quantitative comparison of functional status, pre- and postoperatively.
  
  
  RESULTS
  Thirty-six patients were treated for ASVT throughout the study interval. Seven patients (19.4%) were lost to follow-up. Most patients were male (66%; N = 24); mean age was 32 years. Catheter-directed thrombolysis was utilized in the majority of patients (83.3%; N = 30) with an average time from symptom onset to lysis of 12 days. Surgical decompression was undertaken in all patients via transaxillary (52%; N = 19), supraclavicular (31%; N = 11), or infraclavicular approaches (17%; N = 6). Eleven stents were placed in 11 patients (30.5%) for residual stenotic disease. Mean follow-up was 65 months, with 1- and 5-year overall patency at 100% and 94%, respectively. Freedom from reintervention was 100% and 74.4% at 1 and 5 years, respectively. Seven patients (19.4%) required postoperative reintervention with four receiving additional lytic therapy, two requiring a stent, and one venoplasty. At presentation, 65.5% (N = 19) of patients were unable to work or perform routine activities. After treatment, 86% (N = 25) returned to their employment and have experienced sustained symptomatic and functional improvement.
  
  
  CONCLUSIONS
  Patients with symptomatic idiopathic axillo-subclavian vein thrombosis can expect durable patency with sustained freedom from reintervention following aggressive combined endovascular and surgical treatment. Good functional outcomes can be expected in patients with relief of symptoms and return to work.
authors.affiliation: Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. david.h.stone@hitchcock.org
authors.forename: David H
authors.initials: DH
authors.lastname: Stone
authors.forename: Salvatore T
authors.initials: ST
authors.lastname: Scali
authors.forename: Aja A
authors.initials: AA
authors.lastname: Bjerk
authors.forename: Eva
authors.initials: E
authors.lastname: Rzucidlo
authors.forename: Catherine K
authors.initials: CK
authors.lastname: Chang
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
authors.forename: Brian W
authors.initials: BW
authors.lastname: Nolan
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Walsh
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001367:Axillary Vein / Q000503:physiopathology / Q000601:surgery*; D003131:Combined Modality Therapy; D019091:Critical Pathways; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D015607:Stents; D013350:Subclavian Vein / Q000503:physiopathology / Q000601:surgery*; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D055815:Young Adult
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