2020 Volume 31 Issue 3 Pages 101-105
Primary subclavian vein thrombosis is a rare disease, and this thrombosis often involves stenosis of the subclavian vein in costsubclavical space. Many studies demonstrated that arm elevation and rest coupled with=anticoagulation alone resulted in significant recurrence rates and persistent upper extremity symptoms in more than 50% of cases. Although catheter direct thrombolysis (CDT) for these thrombosis in early onset cases are said to be good result, therefore, CDT is performed as the first treatment. However it often recurs due to central organic stenosis. In this report, we experienced a case of surgery for residual subclavian venous stenosis due to thoracic outlet syndrome after CDT for thrombotic subclavian vein occlusion. The case was a 46Y woman. She visited the hospital with swelling and tightness of the left upper limb that appeared during running. Contrast-enhanced CT and left upper limb venography revealed primary subclavian vein thrombosis. Although CDT was performed and the thrombus disappeared, but stenosis was found on the central side. However she was discharged with taking warfarin(WF) without first rib resection. After she stopped taking WF, subclavian vein thrombosis recurred. We performed surgery following the second CDT. At last, she was taken a surgery, which was infra-subclavian approach, the first rib resection and the patch angioplasty. Although anticoagulant therapy (WF) was discontinued for 6 months after the operation, there was no recurrence of venous thrombosis. Conclusion: The thrombolysis following CDT for primary subclavian vein thrombosis is effective. However, for the patients with stenosis in central side of subclavian vein, the first rib resection and patch angioplasty using the infra-subclavian approach are useful for improving hemodynamics and preventing recurrence of thrombosis and eliminating venous stasis symptoms.
