Surgery for venous thoracic outlet syndrome (TOS) may be required for symptoms ranging from severe recalcitrant arm swelling to acute axillo-subclavian vein thrombosis. The etiology appears to be multi-factorial, involving not only mechanical compression of the subclavian vein between the anterior scalene muscle, first rib, clavicle, subclavius muscle and costoclavicular ligament, but also hematological factors such as acquired and hereditary thrombophilia. Although the visible incisions appear rather small, a sizeable operation is often required to effectively decompress the subclavian vein after clot dissolution. Such surgery and the associated need for postoperative anticoagulation carry a number of risks and considerations. Attention to the many details of successfully helping a patient recover through first rib resection and postoperative care is required for an ultimately successful outcome. This chapter is intended to describe the general approach used in our institution for venous TOS and includes historical considerations and data supporting some of the surgical and medical decision-making.
KeywordsFatigue Catheter Rubber Heparin Morphine
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