Abstract
Of 79 patients seen at the University of Minnesota with symptomatic chronic obstruction
of the axillary subclavian or innominate vein, 65 were considered surgical candidates.
Etiology of the obstruction was as follows: Group A (n = 45), previous subclavian
effort thrombosis; Group B (n = 14), stenosis caused by occupation or sport activities;
and Group C (n = 6), long segments (4–7.2 cm) of obstruction caused by chronic intraluminal
placement of devices (catheters, pacemaker, or defibrillator leads).
Fifty-nine patients (Groups A and B) underwent, via a subclavicular incision, removal
of the first rib and vein patch angioplasty. Six patients (Group C) needed to have
the incision extended transsternally to expose the entire length of the obstructed
vein. In four of them, the subclavian-innominate vein was replaced with a cryopreserved
small thoracic aortic homograft. In the other two, a long vein patch was used.
The long-term success rate with the standard subclavicular incision (Groups A and
B) was 85%; with the extended incision (Group C) it was 83% (patency of homograft,
100%; with the patch, 50%). In nine patients the vein occluded postoperatively (15%)
due to inadequate exposure. We designed a new extended approach through the sternum
in six patients and achieved a 100% success rate.
