Effort subclavian vein thrombosis: Evolution of management

Purpose: To analyze changes in the management of effort subclavian vein thr ombosis at our institution. Methods: Records of 23 patients with effort subclavian vein thrombosis trea ted over a 10-year period were analyzed to compare the results of conventio nal therapy (heparin/warfarin) used in the first half of this period to a m ultimodality treatment strategy (thrombolysis and other adjunctive treatmen t as indicated, e.g., first rib resection, angioplasty/stenting, and vein r econstruction). Diagnostic testing included duplex ultrasound and venograph y All patients had at least 1-year follow-up. Results: Eight patients (7 men; mean age 34 years, range 15-54) had convent ional treatment (group A) and 15 patients (14 men; mean age 36 years, range 17-55) had multimodality therapy (group B). Demographics and clinical char acteristics were comparable for both groups. Initial thrombolysis was achie ved in 14 (93%) group B patients; 10 received adjunctive treatment to relie ve external compression or vein stenosis. Four patients had successful firs t or cervical rib resection and scalenectomy, and first rib resection follo wed by angioplasty/stenting was successful in 2. However, angioplasty and s tenting alone failed in 2 patients, while venous reconstruction was success ful in only 1 of 2 cases. Mean follow-up was 72 months in group A patients and 59 months in group B. One (13%) group A patient and 12 (80%) group B patients demonstrated total venous recanalization and symptom resolution (p = 0.003). Overall, clinical resolution (total and partial symptom relief) was achieved in 3 (38%) grou p A patients and 13 (87%) group B patients (p = 0.026). Conclusions: Initial lyric therapy followed by adjunctive treatment to reli eve external venous compression or venous stenosis is effective in treating patients with effort subclavian vein thrombosis.