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Subclavian vein thrombosis: a continuing challenge
1Department of Surgery, Community Hospital of Roanoke Valley, Roanoke Memorial Hospital, Va.
Insights
Subclavian vein thrombosis, though uncommon, is treatable. Causes include catheters and anatomical issues, with most patients responding well to medical management.
Area of Science:
- Vascular Surgery
- Hematology
Background:
- Subclavian vein thrombosis (SVT) is a rare but serious condition.
- Understanding its causes and effective treatments is crucial for patient outcomes.
Purpose of the Study:
- To investigate the frequency, causes, and optimal treatment strategies for subclavian vein thrombosis.
- To analyze trends in SVT diagnosis despite increased central venous access device use.
Main Methods:
- Retrospective chart review of patients diagnosed with SVT over a 6-year period at two metropolitan hospitals.
- Analysis of patient demographics, causative factors, and treatment modalities.
Main Results:
- 40 cases of SVT identified, representing 3.5% of all venous thromboses.
- Primary causes: anatomic abnormalities (45%), intravenous catheters (32%), and malignancy with radiation (22.5%).
- Most patients (55%) were treated with heparinization; all showed positive responses without progression to venous gangrene or significant pulmonary embolism.
Conclusions:
- Subclavian vein thrombosis is manageable with medical therapy, particularly heparinization.
- Anatomic abnormalities may necessitate surgical intervention.
- No increase in SVT incidence was observed despite increased central venous access device utilization.
Abstract:
Subclavian vein thrombosis is a relatively uncommon but potentially morbid disease entity. To determine the frequency, cause, and best mode of treatment of this problem, we performed a chart review of all patients with a diagnosis of subclavian vein thrombosis at two major metropolitan hospitals during a 6-year period. A total of 40 patients were identified with subclavian vein thrombosis, which represented 3.5% of all venous thromboses detected during the 6-year period. No side or sex predilection was noted and the majority of patients were outpatients. The cause was fairly evenly divided among intravenous catheters (32%), anatomic abnormalities (45%), and carcinoma with postoperative radiation (22.5%). Despite the increasing use of the subclavian veins for pacemaker leads, hyperalimentation, and permanent intravenous access for chemotherapy, there has not been an increase in diagnosed subclavian vein thrombosis. Anatomic abnormalities with compression of the vein respond well to either heparinization or lytic therapy but require surgery if the venous abnormality persists. Treatment consisted of lytic therapy in 20%, heparinization in 55%, and elevation with removal of the central line in 25% of patients. All patients responded well to treatment, with a decrease in swelling and symptoms; no patient progressed to venous gangrene and only one (2.5%) had a documented pulmonary embolus. Medical treatment provides excellent long-term benefit in most cases unless complicated by an anatomic abnormality.