Axillary-subclavian venous occlusion: the morbidity of a nonlethal disease

To evaluate results of medical and surgical treatment of axillary-subclavian venous occlusion, the clinical courses of 95 patients were reviewed. Twenty-three patients had acute axillary-subclavian venous thrombosis, and 72 patients had chronic occlusion. Thirty-four patients with thoracic outlet syndrome and axillary-subclavian occlusion represented 3.5% of the 969 patients treated for thoracic outlet syndrome during the same period. Nonlethal pulmonary embolization from the axillary-subclavian vein occurred in four patients. Sixty percent of patients were asymptomatic or had mild symptoms during strenuous exercise at last follow-up (mean, 5.4 years). Forty-eight of these 56 patients had received anticoagulation during the acute phase of the disease. Twenty-seven percent of patients had symptoms with moderate exercise and 12.6% had symptoms at rest. Thirteen patients had operations, with improvement demonstrable in 10 patients. All five patients who underwent first rib resection for intermittent venous occlusion or for thoracic outlet syndrome after thrombosis occurred on the contralateral side did well. Axillary-subclavian venous occlusion is a nonlethal disease but late sequelae occur in one third of patients. Early anticoagulation appears to be beneficial and, in some patients with concomitant thoracic outlet syndrome, first rib resection also appears to be helpful. Further data are needed to evaluate results of fibrinolytic treatment, thrombectomy, and venous reconstruction.