2007 Abstracts: First Rib Resection and Scalenectomy for Chronically Occluded Subclavian Veins- What does it Really Do?

First rib resection and scalenectomy is an acceptable therapy for those with axillo-subclavian vein thrombosis who have responded to lytic therapy and demonstrated subclavian vein patency. However, the treatment for those patients who present with a chronically occluded subclavian vein is controversial. We present 3 such patients who underwent first rib resection and scalenectomy whose subclavian vein spontaneously opened within the first year following surgery while anticoagulated.
The average age of these patients was 20 (17-23) years old; 2 M; 1 F. The average time interval prior to surgery when the initial thrombosis occurred was 27(12-34) weeks. All three patients were symptomatic and underwent a transaxillary first rib resection and scalenectomy with attention to incise the subclavius tendon. All were maintained on coumadin postoperatively and were surveilled by duplex scan. In all 3 patients, the subclavian vein subsequently opened after an average of 7 (2-9) months and anticoagulation was stopped. The resultant patent subclavian vein correlated with improvement in symptoms in all three patients.
In conclusion, selective symptomatic patients with subclavian vein occlusion can be aggressively treated with first rib resection and scalenectomy along with anticoagulation that will lead to recanalization and opening of the vein over time. This treatment correlates with improvement of their symptoms.