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Related Experiment Videos

Subclavian vein obstruction without thrombosis.

Richard J Sanders1, Sharon L Hammond

  • 1University of Colorado Health Sciences Center, Columbia Rose Medical Center, USA. rsanders@central.com

Journal of Vascular Surgery
|March 16, 2005
PubMed
Summary

Unilateral arm swelling without thrombosis, a type of venous thoracic outlet syndrome (TOS), can be effectively treated with first rib resection. This surgical approach significantly improved symptoms in most patients, offering a viable solution for this uncommon condition.

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Area of Science:

  • Vascular Surgery
  • Thoracic Outlet Syndrome Research
  • Venous Obstruction Studies

Background:

  • Unilateral arm swelling due to subclavian vein obstruction without thrombosis is a rare presentation of venous thoracic outlet syndrome (TOS).
  • Out of 87 patients with venous TOS, only 21 presented without thrombosis.
  • This study focuses on the diagnosis and treatment of these specific patients.

Purpose of the Study:

  • To describe the diagnostic methods and treatment outcomes for patients with unilateral arm swelling caused by non-thrombotic subclavian vein obstruction.
  • To investigate the efficacy of transaxillary first rib resection and venolysis in managing this uncommon TOS variant.

Main Methods:

  • Twenty-one patients with arm swelling and cyanosis underwent dynamic venography, revealing partial subclavian vein obstruction.

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  • Treatment involved transaxillary first rib resection, including the anterior rib and cartilage, along with venolysis.
  • Division of the costoclavicular ligament and subclavius tendon was part of the surgical procedure.

    • Main Results:

    • A significant improvement in symptoms was observed in 18 out of 21 patients (86%), with outcomes rated as good-to-excellent.
    • The treatment approach resulted in only two failures (9%) among the studied cohort.

    Conclusions:

    • Subclavian vein compression at the costoclavicular ligament, often due to congenital proximity or the subclavius tendon, is a likely cause of arm swelling without thrombosis.
    • While neurogenic TOS symptoms like pain and paresthesia may coexist, neck pain and headache are less common.
    • Dynamic venography is crucial for diagnosis, and first rib resection with ligament and tendon division is an effective treatment strategy.