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Objective: Surgical decompression via transaxillary first rib resection (TFRR) is often performed in patients presenting with venous thoracic outlet syndrome (VTOS). We aimed to evaluate the outcomes of TFRR based on chronicity of completely occluded axillosubclavian veins in VTOS., Methods: We performed a retrospective institutional review of all patients who underwent TFRR for VTOS and had a completely occluded axillosubclavian vein between 2003 and 2022. Patients were categorized into three groups based on the time of inciting VTOS event to TFRR acuity of their venous occlusion: <4 weeks, 4 to 12 weeks, and >12 weeks. We evaluated the association of TFRR timing with 1-year outcomes, including patency and symptomatic improvement. We used the χ 2 test to compare baseline characteristics and postoperative outcomes., Results: Overall, 103 patients underwent TFRR for VTOS with a completely occluded axillosubclavian vein (median age, 30.0 years; 42.7% female; 8.8% non-White), of whom 28 had occlusion at <4 weeks, 36 had occlusion at 4 to 12 weeks, and 39 had occlusion at >12 weeks. Postoperative venogram performed 2 to 3 weeks after TFRR demonstrated that 78.6% in the <4 weeks group, 72.2% in the 4- to 12-weeks group, and 61.5% in the >12 weeks group had some degree of recanalization (P = .76). Postoperative balloon angioplasty was successfully performed in 60 patients with stenosed or occluded axillosubclavian vein at the time of postoperative venogram. At the 10- to 14-month follow-up, 79.2% of the <4 weeks group, 73.3% of the 4- to 12-weeks group, and 73.3% of the >12 weeks group had patent axillosubclavian veins based on duplex ultrasound examination (P = .86). Among patients who underwent postoperative balloon angioplasty, 80.0%, 85.0% and 100% in the <4 weeks, 4- to 12-weeks, and >12 weeks groups respectively demonstrated patency at 10 to 14 months (P = .31). Symptomatic improvement was reported in 95.7% in the <4 weeks group, 96.7% in the 4- to 12-weeks group, and 93.5% in the >12 weeks group (P = .84)., Conclusions: TFRR offers excellent postoperative outcomes for patients with symptomatic VTOS, even in cases of completely occluded axillosubclavian veins, regardless of the chronicity of the occlusion. By 14 months, 95.2% of patients experienced symptomatic improvement, and 75% attained venous patency., Competing Interests: Disclosures None., (Copyright © 2024. Published by Elsevier Inc.)

Objective: The purpose of this study was to review preoperative and postoperative duplex scans and postoperative venograms in patients with subclavian vein thrombosis who underwent first rib resection and scalenectomy (FRRS) during 2005 to 2013., Methods: Preoperative venous duplex scans revealed no compression (NC), venous compression (VC, ≥ 50% decrease in velocity on abduction), venous ablation (VA, 0 velocity on abduction), and acute thrombus (AT, 0 velocity on abduction and adduction). Correlation with 2-week postoperative venograms (open, stenosis requiring dilation, or occluded) and postoperative (2- to 4-month, 6- to 8-month, and 12-month) duplex scans was performed., Results: Of 215 patients treated with FRRS for effort thrombosis, 140 had an ipsilateral preoperative duplex scan and postoperative venogram. Twenty-nine patients (21%) had VC, 70 (50%) had VA, 8 (5.7%) had AT, and 33 (24%) had NC. Patients with preoperative NC or VC were more likely to have an open vein on venography (P = .014). Six to 8 months after FRRS, patients with preoperative VA were more likely to have compression or ablation (P = .009); no difference was seen at 1 year. Patency rates at last follow-up were 100% in the preoperative VC and AT groups, 96% in those with VA, and 94% in patients with no preoperative compression. The 128 preoperative scans of the asymptomatic side revealed that 67 patients (52%) had NC, 29 (23%) had VC, 32 (25%) had VA, and 0 had AT. Patients with NC (P = .027), VC (P = .017), or VA (P = .008) were significantly more likely to have the same result on the opposite side., Conclusions: Postoperative duplex scans reveal that VC and VA resolve during the year after FRRS, obviating the need for repeated venography or intervention. Patency rates are excellent in all patients when postoperative venography directs intervention. Patients with NC, VC, or VA on preoperative scans often show the same result on the opposite side., (Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Objective: We have previously demonstrated excellent mid-term patency rates following routine venography after first rib resection and scalenectomy (FRRS) for subacute Paget-Schroetter syndrome. The goal of this study was to assess the long-term outcomes of this technique., Methods: Retrospective analysis of a prospectively collected database was performed. Patients underwent routine venography 2 weeks post-FRRS. Warfarin was discontinued in those with patent veins. Patients with stenotic or occluded veins underwent attempted venoplasty with balloon diameters approximating the size of the anatomically normal vein. Patients with successful venoplasty or chronically occluded veins unable to be dilated were continued on warfarin up to 6 months. Follow-up duplex ultrasound dictated cessation of anticoagulation. Kaplan-Meier analysis was performed for primary, primary-assisted, and secondary patency., Results: A total of 159 patients underwent FRRS and postoperative venography with a median follow-up of 13.8 months. One patient was lost to follow-up. The median time to FRRS after the initial onset of symptoms was 4.1 months. At the time of venography, there were 42 patent, 72 stenotic, and 44 occluded veins. Of the 44 occlusions, 25 underwent venoplasty, and 19 could not be crossed. In the entire group, restenosis occurred in seven patients and reocclusion in seven. At last follow-up, six patients remained occluded. Eighteen-month primary patency of venoplasty was 95.4% ± 2.6% in the stenotic group and 75.6% ± 8.7% in the occluded group. Eighteen-month primary-assisted patency of venoplasty was 98.3% ± 1.7% in the stenotic group and 96.0% ± 3.9% in the occluded group. Overall secondary patency at 3 years was 100% in the patent group, 98.4% ± 1.6% in the stenotic group, and 92.9% ± 3.9% in the occluded group., Conclusions: Long-term venous patency rates after limited venoplasty and anticoagulation following FRRS are excellent. Furthermore, prolonged anticoagulation for occlusions that could not be crossed or in those who reocclude after venoplasty results in recanalization and delayed patency. These results argue against the need for stenting or open venous reconstruction and serve as a benchmark for the care of patients with subacute Paget-Schroetter syndrome., (Copyright © 2014 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)