Midterm Outcomes after Delayed First Rib Resection for Acute Axillosubclavian Deep Vein Thrombosis in...

The standard treatment for axillosubclavian deep venous thrombosis (DVT) in Paget-Schroetter syndrome typically includes thrombolysis, first rib resection, and, when needed, percutaneous transluminal venoplasty (PTV) or stenting. Our institution adopted a simplified approach using anticoagulation alone followed by delayed first rib resection (3-6 months) without thrombolysis. This study evaluates its clinical effectiveness.

We conducted a retrospective cohort study of patients who underwent first-rib resection for upper-extremity DVT in Paget-Schroetter syndrome between January 2017 and July 2024, using a prospectively maintained database. The primary endpoint was postoperative clinical improvement. We also analyzed patient demographics, venous involvement, hypercoagulable status, and anticoagulation duration.

Of 27 identified patients, 8 who underwent thrombolysis were excluded. Among the 19 patients (mean age 28.4 years; 13 males), all presented with arm swelling and pain. The subclavian vein was involved in 15 patients and the axillary vein in 4. Eleven patients were involved in competitive sports. Mean preoperative anticoagulation duration was 5.9 ± 2.1 months and was discontinued postoperatively. Most patients underwent transaxillary first rib resection. Postoperative duplex showed complete DVT resolution in 16 patients and partial or chronic DVT in 3. Four patients required intraoperative PTV for symptomatic stenosis. At a mean follow-up of 20.3 ± 22.1 months, 17 patients were symptom-free, while 2 required additional PTV.

Anticoagulation followed by delayed first rib resection provides effective short-term symptom relief. Avoiding thrombolysis simplifies management and may reduce risks and costs while maintaining favorable outcomes. Further studies are needed to assess long-term efficacy.