LOCAL THROMBOLYTIC THERAPY IN EFFORT AXIL LARY-SUBCLAVIAN VEIN-THROMBOSIS

From March 1989 to March 1993, six athletic patients were treated in o ur institution by thrombolytic therapy for acute effort axillary-subcl avian vein thrombosis in thoracic outlet syndrome. Mean age of these p atients was 20 (range 14 to 27). An in situ infusion with urokinase (2 ,500 U/kg/h) and Heparin (100 U/kg/12 hours) was given during 64 hours (Range 14 to 72). Phlebography showed a complete reperfusion in three cases (the treatment began within an average period of 5.6 days), par tial reperfusion fusion in two cases (the treatment began within an av erage period of 8.5 days). In one case there was no reperfusion on phl ebography : treatment began within an average period of 15 days. For t his patient, a venous axillojugular bypassgraft was performed. In all cases, there was no bleeding complication. A trans-axillary first rib resection was done three months later. Mean follow up was 31 months (r ange : two to 51 months). All patients recovered their previous physic al status. Echo-Doppler exam showed normal subclavian vein flow in fou r cases, partial occlusion in one case and a total occlusion of the su bclavian vein flow in one case. In this last case, the thrombolytic th erapy failed to restore the permeability of the subclavian vein. Bypas sgraft was patent. Axillary-subclavian vein thrombosis seen within a p eriod of seven days should be treated by local thrombolytic therapy us ing urokinase and heparin.