SUBCLAVIAN VEIN-THROMBOSIS - MEDICAL-TREA TMENT

Thromboses of the subclavian vein are rare. However there is a higher incidence due to the increasing use of central venous catheters and pa cemakers. Thoracic outlet syndrome is no longer the main cause. Thromb oses may be clinically apparent, however when they are caused by the i nsertion of a catheter, thromboses may be symptom-free. Phlebography i s the gold standard for the diagnosis. B mode ultra-sounds may give fa lse results in that particular location. The optimum treatment of subc lavian thromboses should prevent the occurence of pulmonary embolisms, and the development of post-thrombotic syndrome. Heparin followed by anti-vitamin K meets these two objectives in the majority of cases. Th e risks of thrombolytic therapy is, in our opinion, unacceptable to pr omote thrombolysis to treat upper limb venous thrombosis. Surgery is i ndicated in cases of phlematia caerulea which are extremely rare, and in cases of septic thrombosis. The preventive treatment of the opposit e side of a symptomatic thoracic outlet syndrome, is questionnable, ex cept in the case where the findings of the clinical examination, B mod e ultrasound and phlebography results, are in favor of a intermittent compression of the vein with a risk of thrombosis.