Abstract
In some cases, the chronic obstructive fibrotic process involving the subclavian vein extends far medially. In this instance, the standard incision is inadequate to expose the normal innominate vein or to properly lay the patch at its proximal end. The problem is not so much the actual length of the obstructed segment of vein, but that, if the segment has obviously extended into the innominate vein behind the manubrium of the sternum, the exposure needed to lay a patch appropriately or to connect proximal and distal normal vein is impossible to achieve. Therefore the regular incision needs to be extended into the sternum in order to expose the innominate vein, in some cases even up to the origin of the superior vena cava (Fig. 20.1a, b). The surgeon must keep in mind several caveats and injunctions when contemplating the use of this extension. First, once the sternum is entered, it is of the utmost importance in the postoperative period to keep the patient’s arm immobilized for a minimum of 6 weeks postoperatively to allow the sternum to heal and to prevent a dehiscence. This will almost certainly occur if the patient is allowed to move the arm freely in all directions even if a proper sternal repair has been achieved at the end of the operation. Second, the extension should not be done until an attempt is made to use the regular incision to try to mobilize the vein into the operative field for placement of the venous patch (Fig. 19.11). Even when the clamps are already on the vein and the vein has been opened, extension of the incision can be carried out with the clamps in place until the manubrium of the sternum is divided. Because the patient has already been Heparinized, no thrombosis will occur.
Keywords
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Molina JE. A new surgical approach to the innominate and subclavian vein. J Vasc Surg. 1998;27:576–81.
Molina JE. Approach to the confluence of the subclavian and internal jugular veins without claviculectomy. Semin Vasc Surg. 2000;13:10–9.
Molina JE. Use of cryopreserved small aortic homografts for large vein replacement. Vasc Surg. 1999;33:545–55.
Molina JE. Operative technique of first rib resection via subclavicular approach. Vasc Surg. 1993;27:667–71.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media New York
About this chapter
Cite this chapter
Molina, J.E. (2013). The Transsternal Extension. In: New Techniques for Thoracic Outlet Syndromes. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5471-7_20
Download citation
DOI: https://doi.org/10.1007/978-1-4614-5471-7_20
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-5470-0
Online ISBN: 978-1-4614-5471-7
eBook Packages: MedicineMedicine (R0)