Timing for Intervention and Standard of Care

Abstract

From its initial reports it was clear that prompt intervention was indicated to treat subclavian vein thrombosis. In an extensive review published in 1934 [1] Matas, recognized that, even though etiology of the problem was unknown at that time, the presence of persistent edema and pain in the arm warranted an urgent exploratory operation. He recommended thrombectomy, because, in his words, “waiting was not a logical option; so called expectant treatment should yield without too a long delay to surgical exploration for the seat of the lesion.” Läwen [2] in 1937 proposed the same approach and reported several cases of thrombectomy, noting that the earlier the thrombectomy was undertaken, the better the results obtained in relieving the symptoms of venous obstruction. Drapanas [3] reported a small series of cases treated with emergency thrombectomy with good reestablishment of flow and gratifying relief of symptoms. He stressed that emergency thrombectomy appeared to offer the best possibility for restoring the upper extremity to normal in a very short period of time using a relatively simple procedure and to prevent extensive organization of thrombus, therefore avoiding all sequels of this disease. Mahorner and others came to believe [4] that removal of the thrombus in the early stage was the only procedure of any benefit to treat this condition.