Primary subclavian vein thrombosis and its long-term effect on quality of life

We aimed to compare the long-term results of three different strategies for treatment of patients with primary (spontaneous or effort related) subclavian vein thrombosis (PSVT). We followed 45 consecutive patients who had been treated for PSVT receiving either oral anticoagulant therapy only (n = 14, group 1); thrombolysis followed by anticoagulant therapy (n = 14, group 2); or thrombolysis, transaxillary first rib resection and anticoagulant therapy (n = 17, group 3). Endpoints were persisting symptoms and quality of life (QoL). The latter was assessed with the EuroQol (EQ-5D) questionnaire at the end of follow-up. The design is a case-control study with three different groups. Predictors for residual symptoms and QoL were analyzed with logistic and linear regression analysis. Patients in groups 2 and 3 had significantly less pain, swelling and fatigue in the afflicted limb at six weeks. There was no difference in pain (P = 0.90), swelling (P = 0.58), fatigue (P = 0.61), functional impairment (P = 0.61), recurrence (P = 0.10) or QoL (P = 0.25) between groups at the end of follow-up (mean follow-up 57 months [range 2-176, SD ± 46]). Treatment strategy was not predictive of QoL (P = 0.91, analysis of variance). No differences in long-term symptoms or QoL between patients with successful and unsuccessful thrombolysis were present. In conclusion, thrombolysis with or without first rib resection does not appear to contribute to lasting symptom reduction and improvement of QoL in this study. The effect of thrombolysis may be limited to short-term symptom relief. Transaxillary first rib resection was not associated with improved late outcome (symptoms, QoL) and did not reduce recurrence rate.