Characteristic computed tomography findings in patients with left upper limb edema after innominate vein resection

Thrombus in the subclavian and internal jugular veins can occur after resection of the left innominate vein in patients with mediastinal tumors, for whom anticoagulants are generally administered. However, no evidence exists that anticoagulants should be discontinued in such patients.

Between 2009 and 2024, 913 patients underwent surgical interventions for mediastinal tumors. Among them, 19 patients who underwent left innominate vein resection were included, excluding 14 who had superior vena cava reconstruction. The clinical features and computed tomography (CT) findings of the preoperative, acute (within 30 days), and chronic (after 30 days) phases were evaluated.

Eleven male patients, with a mean age of 57 years, underwent surgery via hemi-clamshell (11), median sternotomy (5), and robotic approaches (3). Twelve patients had left-arm edema, while nine underwent enhanced CT in the acute phase. Six patients developed thrombosis of the left innominate vein stump and were managed using anticoagulants. The characteristic findings in the acute phase included skin thickness, fluid collection, and subcutaneous and axillary high-fat content (7/9). These findings resolved in the chronic phase, regardless of thrombus presence (0/19). All patients exhibited peripheral vascular dilation (1.3-3.3 folds). Among those with thrombus, two had residual thrombus after 1 year, but no exacerbation was observed after discontinuing antithrombotic therapy.

CT findings post-left innominate vein resection demonstrated disappearance in the acute phase and confirmed peripheral vascular dilation, suggesting minimal thrombus worsening factors. These findings should be confirmed when considering the discontinuation of anticoagulant therapy.