TY - JOUR
T1 - Surgery for effort thrombosis of the subclavian vein
AU - Molina, J. E.
N1 - Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 1992
Y1 - 1992
N2 - 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 (< 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.
AB - 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 (< 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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U2 - 10.1016/s0022-5223(19)35036-6
DO - 10.1016/s0022-5223(19)35036-6
M3 - Article
C2 - 1735999
AN - SCOPUS:0026577219
SN - 0022-5223
VL - 103
SP - 341
EP - 346
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 2
ER -