McCleery syndrome: etiology and outcome

Patients presenting with swelling of the upper extremity without thrombosis have McCleery syndrome or intermittent compression of the subclavian vein. The purpose of this study was to determine outcomes in these patients who underwent first rib resection and scalenectomy (FRRS).

Using a prospectively maintained database from 2003 to 2011, patients were retrospectively reviewed for presentation, diagnosis, treatment, and clinical outcomes.

Of the patients presenting with venous thoracic outlet syndrome, 19 (11%; 13 F/6 M; mean age 26 [10-44]) presented with intermittent arm swelling, of which 3 were identified as having chronic thrombus. A total of 20 FRRS operations were performed.

First rib resection and scalenectomy is effective in relieving symptoms in patients with McCleery syndrome. These patients do not generally need a postoperative venogram unless they experience continuing symptoms. In patients with chronic thrombus, routine postoperative venography at 2 weeks is indicated. Patients can present with intermittent compression if an acute episode of deep vein thrombosis is not aggressively treated.