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Complete reconstruction of the subclavian vein following thrombotic occlusion at the costo-clavicular level

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Pain in Shoulder and Arm

Part of the book series: Developments in Surgery ((DISU,volume 1))

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Abstract

Three different types of occlusion of the subclavian veins in two patients are presented. All are typical complications arising from a narrowed costo-clavicular interspace in connection with scapulo-thoracic passage pathology.

Some striking disagreement is evident between the “classical” concept of benignity of the axillo-subclavian venous occlusions and the conclusions of many reports published upon the evaluation of the respective late results of conservative and operative treatments. The high incidence of post-thrombotic sequelae advocates more selective therapeutic programmes in consideration of specific etiology in each instance. The causes of the various types of venous occlusion is discussed and it is suggested that in each case, the constitutional, determinative and eventually additional temporary factors should be systematically sought. The understanding of this pathology would be therefore clearer and the therapeutic guidelines more complete and adequate. When present, a segmental organized lesion of the subclavian vein at the costoclavicular level-which becomes the source of additional severe thrombotic complications-, can be corrected by combination of:

  • First rib resection.

  • Endophlebectomy with excision of the terminal valve of the subclavian vein, included in the intraluminar fibrotic tissue.

  • Occasional enlargement angioplasty of the junction of the subclavian and the brachiocephalic veins.

  • Closure of the subclavian phlebotomy with a large and rectangular autologous saphenous vein patch graft.

These procedures have been performed successfully in three instances through a combined subclavian and partial unilateral sternotomy approach permitting lateral retraction of the clavicle and the 2 first ribs. Final cosmetic aspect is very satisfactory.

Such restoration of the subclavian vein is indicated in selected cases in whom complete functional rehabilitation is essential. It is emphasized that the relative merits of the medical, physical and various surgical treatments — including the complete repair of the vein — should be discussed for each venous problem arising in a pathological scapulo-thoracic passage, with consideration for the general condition and capability requirements of the patient.

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Authors and Affiliations

  1. Clinique F.S.S. de Herstal, Institut de Chirurgie — Clinique A (Prof. D. Honoré) Universite de Liège, Belgium

    M. A. Beaujean M.D.

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  1. M. A. Beaujean M.D.
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  1. Maastricht, The Netherlands

    J. M. Greep M.D.  & H. A. J. Lemmens M.D.  & 

  2. Denver, USA

    D. B. Roos M.D.

  3. Dallas, USA

    H. C. Urschel M.D.

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© 1979 Martinus Nijhoff Publishers, The Hague/Boston/London

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Beaujean, M.A. (1979). Complete reconstruction of the subclavian vein following thrombotic occlusion at the costo-clavicular level. In: Greep, J.M., Lemmens, H.A.J., Roos, D.B., Urschel, H.C. (eds) Pain in Shoulder and Arm. Developments in Surgery, vol 1. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-9303-7_24

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  • DOI: https://doi.org/10.1007/978-94-009-9303-7_24

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