Routine Venography Following Transaxillary First Rib Resection and Scalenectomy (FRRS) for Chronic Subclavian Vein Thrombosis Ensures Excellent Outcomes and Vein Patency

Abstract

To assess the role of postoperative venography in patients treated with first rib resection and scalenectomy (FRRS) for effort thrombosis, a retrospective review was done to evaluate long-term venous patency in 84 patients treated at the Johns Hopkins Medical Institutions. Patients undergo venography 2 weeks postoperatively. If there is >50% stenosis, the subclavian vein is dilated and the patient receives anticoagulation. If the vein is occluded, patients are maintained on anticoagulation. Of the 85 patients, 21 patients had patent veins, 47 patients had stenotic veins, and 16 patients had chronically occluded veins. In follow-up, symptomatic restenosis was seen in 3 patients and those veins were redilated. Two other patients had late occlusions at 23 and 63 months and received anticoagulation and redilatation, respectively. Using venography to guide postoperative management, 79 of 84 patients had patent veins many years postoperatively. Long-term patency, as seen by duplex scan, was achieved in nearly all patients using this protocol.

Overuse injuries and burnout in youth sports: a position statement from the American Medical Society for Sports Medicine

“…178 The most extensive report of venous TOS in adolescents was recently published. 179 This study described 17 adolescents with subclavian vein thrombosis (age range 10-18 years). Ten of these 17 cases were associated with athletic activities or overuse in other activities.…”

“…In addition, all patients with effort thrombosis should undergo evaluation for an underlying coagulopathy. 179 BURNOUT Burnout may be thought of as part of a spectrum of conditions that includes over-reaching and overtraining. Over-reaching may be functional or non-functional.…”

“…Testing (if indicated by history) Consider laboratory studies: complete blood count, comprehensive metabolic panel, erythrocyte sedimentation rate, C reactive protein, iron studies, creatine kinase, thyroid studies, cytomegalovirus and Epstein-Barr virus titres.Profile of Mood States (POMS): a psychometric tool for a global measure of mood, tension, depression, anger, vigour, fatigue and confusion 179. …”

Paget-Schroetter Syndrome

“…But if it occurs, in over 90 % neurological symptoms coexist, due to compression of brachial plexus (9,10). In presented ommend early and routine decompression, due to suboptimal results, higher incidence of recurrent thrombosis and residual symptoms with delayed surgery (4)(5)(6)8).…”

“…As postoperative complications nerve, vein or artery injury, bleeding or pneumothorax were noted. The balance between risks and benefits of surgery is crucial (1,8,10). Anticoagulation is also required after surgical decompression.…”