Excellent Results Seen in Both Transaxillary and Infraclavicular Approach to First Rib Resection in Patients with Subclavian Vein Thrombosis
Lydia L Faber, Gabriela Velazquez-Ramirez, Randolph Geary, Kevin Z Chang, Matthew P Goldman, Julie Freischlag
Wake Forest Baptist Medical Center, Winston-Salem, NC
Venous Thoracic outlet syndrome (vTOS) represents a debilitating condition with several well-documented treatment paradigms. Outcomes from a large academic institution comparing patients who underwent transaxillary first rib resection with delayed venogram (TA) and to an infraclavicular first rib resection and concomitant venogram (ICV) for vTOS with subclavian vein thrombosis were reviewed. Methods
Retrospective review of medical records for all patients treated with a first rib resection for vTOS with subclavian vein thrombosis at a single academic institution were reviewed. Demographics, presentation, operative records, and outcomes were collected. Descriptive statistics were used to compare both groups.
72 patients underwent first rib resection for vTOS during the study period, 36 (50%) presented with thrombosis of the subclavian vein and were included in this review. Twenty-six patients (72%) underwent TA while 10 (28%) patients underwent ICV. No significant differences seen in the groups regarding female gender (54% vs. 50%; P =1) or age (28.7 vs. 29.5; P = .88). A higher percentage of the ICV group underwent preoperative thrombolysis (70% vs. 27%; p = .02). All patients in the ICV group underwent intraoperative venoplasty at the time of resection, the mean time from thrombosis to resection was 2.3 months. The TA group all underwent venogram two weeks post-operatively which revealed: 15 stenotic veins requiring venoplasty, 8 widely patent veins, 1 acutely thrombosed vein, and 3 chronically occluded veins. Time from initial thrombosis to surgical intervention was 10 months in the patent group, 6 months in the stenotic group, and 4 months in the occluded group.
In the TA group, 19% of patients required chest tube placement intraoperatively for pneumothoraces. In the ICV group, complications included postoperative hematoma (n=1), wound infection (n=1), hemothorax (n=1). Mean length of stay was 1.04 days for TA group and 2.00 days for ICV group (P < 0.0001).
Mean follow up was 10.4 months and 15.8 months respectively. No mortalities were reported. No difference in vein patency rates was seen between groups at follow up (TA 93% vs. ICV 100%; P = 1). All patients were asymptomatic at follow up.
Outcomes in patients undergoing TA or ICV for subclavian vein thrombosis are excellent with no mortalities and few complications. Patency rates were high and all patients were asymptomatic at follow up.
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