Outcome after thrombolysis and selective thoracic outlet decompression forprimary axillary vein thrombosis

Purpose: Treatment for primary subclavian-axillary vein thrombosis (SAVT) a t our institution consists of thrombolysis and anticoagulation for 3 months . Thoracic outlet decompression has been performed for a small number of pa tients. We wanted to review the functional outcomes of patients treated in such a manner. Material and Methods: The records of all patients treated for a first episo de of SAVT at our hospital over the past 10 years were reviewed. Demographi cs, comorbidities, method of diagnosis, and treatment for SAVT were recorde d. Longterm follow-up was obtained by chart review and asking patients to c omplete the DASH (disabilities of the arm, shoulder and hand) questionnaire that was developed by the American Academy of Orthopedic Surgeons. Results: Twenty-eight patients, 20 men and eight women, with a mean age of 36 were treated during the study period. The median time between onset of s ymptoms and treatment was 5.5 (range, 1-100) days. All patients had confirm ation of the diagnosis by venography. Twenty-five patients received thrombo lytic treatment with catheter-directed infusions of urokinase; in the other three patients the vein was chronically occluded. Twelve patients had some degree of residual stenosis and were treated with percutaneous translumina l angioplasty after thrombolysis. During the study period two patients unde rwent decompressive surgery. Twenty-one patients responded to the DASH ques tionnaire a mean of 2.9 years (range, 2 months to 8 years) after the episod e of SAVT. Six (28%) of 21 patients were completely symptom free, 13 patien ts (62%) had DASH scores consistent with mild symptoms, and two patients ha d more severe symptoms. Twenty percent (4 of 21) of patients report some di fficulty with work. Conclusions: Thrombolysis, followed by selective thoracic outlet decompress ion on the basis of the severity of patients' symptoms can be used as a the rapeutic approach to SAVT without undue morbidity. The DASH questionnaire i s a useful tool to evaluate results after therapy for SAVT.