SUBCLAVIAN VEIN-THROMBOSIS - OUTCOME ANALYSIS BASED ON ETIOLOGY AND MODALITY OF TREATMENT

Therapeutic options for subclavian vein thrombosis (SVT) include antic oagulation, thrombolysis, endovascular repair, and direct surgical int ervention. The most effective method of treatment remains undetermined . We reviewed our institutional experience over 7 years with SVT patie nts to compare the results of treatment based on etiology of thrombosi s. Nineteen patients suffered SVT secondary to malignancy, catheter pl acement, radiation, or hypercoagulability. Thirteen were Paget-Schroet ter (PSS), or primary effort-related SVT. Patients with dialysis acces s procedures were excluded. Thrombolysis was initiated in 31/32 patien ts. Success was defined as complete obliteration of clot. Adjunctive t reatment to relieve external compression or improve lumenal contour wa s performed on 16/32 patients (eight PSS, eight secondary SVT). Succes s of adjunctive treatment was defined as return to baseline activity w ithout symptoms. Objective follow up (venography or duplex scanning) w as included when available. Adjunctive treatment included balloon angi oplasty (6), stent placement (5), first rib resection and scalenectomy (4), and vein reconstruction (4). Initial treatment success with thro mbolysis was achieved in 26/31 patients (84%). Angioplasty failed in t hree PSS and three secondary SVT patients. Stent placement was success ful in 2/5 patients (both secondary SVT). Surgery was performed only o n PSS patients: first rib resection and scalenectomy succeeded 4/4 tim es, vein reconstruction 2/4. Twenty-eight patients were given long-ter m therapy with oral anticoagulation with good longterm results. Seven patients experienced complications, including one death. Results of SV T therapy including thrombolysis and oral anticoagulation are very goo d. Angioplasty and stent placement in secondary SVT patients appears t o add little long term benefit. Surgery may improve outcome in selecte d PSS patients, although the additional benefit could not be determine d by the design of this study. Evaluation and treatment limited only t o PSS excludes the majority of SVT patients.