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Claviculectomy for subclavian venous repair: long-term functional results
R M Green1, D Waldman, K Ouriel
1Center for Vascular Disease and the Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Insights
Medial claviculectomy with venous repair for subclavian vein thrombosis offers durable, excellent long-term function. Most patients return to their previous vocation without limitations, demonstrating successful surgical outcomes.
Area of Science:
- Vascular Surgery
- Orthopedic Surgery
- Thrombosis Management
Background:
- Effort thrombosis of the subclavian vein can impair arm function.
- Incomplete thrombolysis necessitates further intervention for venous patency.
Purpose of the Study:
- To evaluate long-term functional outcomes after medial claviculectomy and venous reconstruction for subclavian vein effort thrombosis.
- To assess the durability and success of venous patch angioplasty or bypass grafting using internal jugular vein.
Main Methods:
- Retrospective review of 11 patients treated over 9 years.
- Follow-up included duplex imaging, contrast venography, and orthopedic shoulder evaluation.
- Mean follow-up duration ranged from 3 to 9 years.
Main Results:
- All reconstructed veins remained patent; only one patient reported mild arm swelling.
- All patients returned to their previous occupations without functional limitations.
- Minor symptoms like paresthesias or aching with overuse were reported by some, but overall function was excellent.
Conclusions:
- Medial claviculectomy with early subclavian venous repair is a durable procedure.
- Excellent long-term functional results are achievable, with all patients returning to normal activities.
- Despite minor symptoms in some, the overall functional success is high.
Objectives:
The purpose of this study was to determine the long-term functional results after medial claviculectomy and venous patch angioplasty or bypass grafting using internal jugular vein after incomplete thrombolysis of effort thrombosis of the subclavian vein.
Methods:
The records of 11 patients with effort thrombosis who were treated over the past 9 years were reviewed. Patients have been followed up between 3 and 9 years at 6-month intervals with duplex imaging and contrast venography when indicated and have had an orthopedic evaluation of their shoulder function.
Results:
All reconstructed veins are patent, and only one patient complains of any arm swelling after prolonged usage. This patient is one of three with postphlebitic changes at the site of repair and has similar findings in her basilic vein. All patients have returned to their prethrombosis vocation without limitation. Four of the 11 patients have jobs requiring heavy physical labor. No patient describes any limitations of shoulder function, but one man who works as a diesel mechanic complains of shoulder aching with overuse with repetitive pulling. Three patients describe upper extremity paresthesias when lying on the operated side. Two patients (one man and one woman) are bothered by the large scar and indentation at the site of the incision. Every patient considers the overall result completely successful from a functional standpoint.
Conclusions:
Early subclavian venous repair performed through a medial claviculectomy is a durable operation with excellent long-term functional results. Half of the patients noted minor but significant symptoms, but all are uniformly able to return to normal function.
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