title: Routine venography following transaxillary first rib resection and scalenectomy (FRRS) for chronic subclavian vein thrombosis ensures excellent outcomes and vein patency.
abstract: To assess the role of postoperative venography in patients treated with first rib resection and scalenectomy (FRRS) for effort thrombosis, a retrospective review was done to evaluate long-term venous patency in 84 patients treated at the Johns Hopkins Medical Institutions. Patients undergo venography 2 weeks postoperatively. If there is >50% stenosis, the subclavian vein is dilated and the patient receives anticoagulation. If the vein is occluded, patients are maintained on anticoagulation. Of the 85 patients, 21 patients had patent veins, 47 patients had stenotic veins, and 16 patients had chronically occluded veins. In follow-up, symptomatic restenosis was seen in 3 patients and those veins were redilated. Two other patients had late occlusions at 23 and 63 months and received anticoagulation and redilatation, respectively. Using venography to guide postoperative management, 79 of 84 patients had patent veins many years postoperatively. Long-term patency, as seen by duplex scan, was achieved in nearly all patients using this protocol.
authors.affiliation: Division of Vascular and Endovascular Surgery, Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA. kchang29@jhmi.edu
authors.forename: Kevin Z
authors.initials: KZ
authors.lastname: Chang
authors.forename: Kendall
authors.initials: K
authors.lastname: Likes
authors.forename: Jasmine
authors.initials: J
authors.lastname: Demos
authors.forename: James H
authors.initials: JH
authors.lastname: Black
authors.forename: Julie A
authors.initials: JA
authors.lastname: Freischlag
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D015142:Baltimore; D002404:Catheterization; D002908:Chronic Disease; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010027:Osteotomy; D010690:Phlebography; D011237:Predictive Value of Tests; D012008:Recurrence; D012189:Retrospective Studies; D012272:Ribs / Q000601:surgery*; D013350:Subclavian Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D056824:Upper Extremity Deep Vein Thrombosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014654:Vascular Patency
chemical_list: D000925:Anticoagulants