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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 341-346, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Surgery for effort thrombosis of the subclavian vein

JE Molina
Department of Surgery, University of Minnesota Hospital and Clinic, Minneapolis.

Between February 1988 and March 1991, 28 patients with effort thrombosis of the subclavian vein were treated with a combined approach of thrombolytic therapy followed by surgical therapy. Three categories were seen: group I (six patients), acute stage (less than 5 days); group II (seven patients), subacute stage (6 days to 2 weeks); and group III (15 patients), chronic stage (more than 2 weeks). Group III was divided into two subgroups: subgroup A, seven patients with a short- obstructed segment (less than 1/2 inch), and subgroup B, eight patients with a long-obstructed segment (1 to 6 inches). During venography a catheter is placed within the thrombus for continuous infusion of urokinase (3000 U/kg/hr) for 12 to 24 hours. After complete clot lysis, resection of the first rib via a subclavicular approach is undertaken. Vein patch angioplasty was required in two patients in group I, six in group II, and seven in group III, subgroup A. Bypass of long-obstructed vein segments was attempted in only four (group III, subgroup B). Decompression and reestablishment of normal vein caliber was achieved in 100% of groups I and II and in 86% of group III, A. In only one patient of group III, B, a saphenous vein bypass remained open (25%). Operative technique is described.

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