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<h5 class="section-title" id="d11028058e180">Objective</h5>
<p id="P1">While much attention has been devoted toward treatment paradigms for idiopathic
axillo-subclavian
vein thrombosis (ASVT), little has focused on long-term durability of aggressive treatment
and its associated functional outcomes. The purpose of this study was to review our
own surgical therapeutic algorithm and its associated durability and functional outcomes.
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<h5 class="section-title" id="d11028058e185">Methods</h5>
<p id="P2">All patients treated with combined endovascular and open surgery at Dartmouth-Hitchcock
Medical Center for ASVT from 1988 to 2008 were identified. Patient demographics, comorbidities,
and operative techniques were recorded. Patency, freedom from reintervention, and
functional outcomes were documented. Follow-up via telephone and clinic visit allowed
quantitative comparison of functional status, pre- and postoperatively.
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<h5 class="section-title" id="d11028058e190">Results</h5>
<p id="P3">Thirty-six patients were treated for ASVT throughout the study interval.
Seven patients
(19.4%) were lost to follow-up. Most patients were male (66%; N = 24); mean age was
32 years. Catheter-directed thrombolysis was utilized in the majority of patients
(83.3%; N = 30) with an average time from symptom onset to lysis of 12 days. Surgical
decompression was undertaken in all patients via transaxillary (52%; N = 19), supraclavicular
(31%; N = 11), or infraclavicular approaches (17%; N = 6). Eleven stents were placed
in 11 patients (30.5%) for residual stenotic disease. Mean follow-up was 65 months,
with 1- and 5-year overall patency at 100% and 94%, respectively. Freedom from reintervention
was 100% and 74.4% at 1 and 5 years, respectively. Seven patients (19.4%) required
postoperative reintervention with four receiving additional lytic therapy, two requiring
a stent, and one venoplasty. At presentation, 65.5% (N = 19) of patients were unable
to work or perform routine activities. After treatment, 86% (N = 25) returned to their
employment and have experienced sustained symptomatic and functional improvement.
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<h5 class="section-title" id="d11028058e195">Conclusions</h5>
<p id="P4">Patients with symptomatic idiopathic axillo-subclavian vein thrombosis
can expect
durable patency with sustained freedom from reintervention following aggressive combined
endovascular and surgical treatment. Good functional outcomes can be expected in patients
with relief of symptoms and return to work.
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