Utilization of venous duplex scanning and postoperative venography in patients with subclavian vein thrombosis

The purpose of this study was to review preoperative and postoperative duplex scans and postoperative venograms in patients with subclavian vein thrombosis who underwent first rib resection and scalenectomy (FRRS) during 2005 to 2013.

Preoperative venous duplex scans revealed no compression (NC), venous compression (VC, ≥ 50% decrease in velocity on abduction), venous ablation (VA, 0 velocity on abduction), and acute thrombus (AT, 0 velocity on abduction and adduction). Correlation with 2-week postoperative venograms (open, stenosis requiring dilation, or occluded) and postoperative (2- to 4-month, 6- to 8-month, and 12-month) duplex scans was performed.

Of 215 patients treated with FRRS for effort thrombosis, 140 had an ipsilateral preoperative duplex scan and postoperative venogram. Twenty-nine patients (21%) had VC, 70 (50%) had VA, 8 (5.7%) had AT, and 33 (24%) had NC. Patients with preoperative NC or VC were more likely to have an open vein on venography (P = .014). Six to 8 months after FRRS, patients with preoperative VA were more likely to have compression or ablation (P = .009); no difference was seen at 1 year. Patency rates at last follow-up were 100% in the preoperative VC and AT groups, 96% in those with VA, and 94% in patients with no preoperative compression. The 128 preoperative scans of the asymptomatic side revealed that 67 patients (52%) had NC, 29 (23%) had VC, 32 (25%) had VA, and 0 had AT. Patients with NC (P = .027), VC (P = .017), or VA (P = .008) were significantly more likely to have the same result on the opposite side.

Postoperative duplex scans reveal that VC and VA resolve during the year after FRRS, obviating the need for repeated venography or intervention. Patency rates are excellent in all patients when postoperative venography directs intervention. Patients with NC, VC, or VA on preoperative scans often show the same result on the opposite side.