37  Acute Axillary/Subclavian Vein Thrombosis	385

Fig. 37.2  Algorithm for treatment options in acute axillary/subclavian vein thrombosis

Acute axillary/subclavian vein thrombosis

Screening for thrombophilia

	Venography
	Secondary thrombosis		Primary thrombosis
	Consider
	conservative treatment		Heparin (systemic)
	Heparin/oral anticoagulation		Thrombolytic therapy
			Control venography
			Oral anticoagulation and
			observation for 1-3 months
		Symptomatic		Asymptomatic
		Operative relief		Conservative
				management
		of thoracic outlet
	Asymptomatic			Symptomatic
		(1.rib resection)
	Conservative			Venous obstruction
	management

Balloon angioplasty or venous reconstruction

In summary the most effective sequence to restore venous patency and reduce rethrom- bosisseemsthustoincludelocalthrombolytictherapy,1–3monthsoforalanticoagulation, and then transaxillary first-rib resection with venolysis in patients who have significant symptoms at this stage. Thereafter, occasionally percutaneous transluminal angioplasty (PTA) or venous reconstruction may be indicated.21,22 Following such a staged multidisiplinary treatment (Fig. 37.2) the disability rate following acute axillary/subclavian trombosis has been significantly reduced.19

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