In Reply to: Re: Case 0298_10 --Mechanical thrombolysis for effort vein thrombosis posted by Moni Stein on February 04, 1998 at 15:27:16:
Having had miserable medium and long term results with stenting the subclavian vein in dialysis patients, I've never tried stenting in the setting of effort thrombosis. In the six cases of effort thrombosis we've had over the past four years, I have treated all with urokinase followed, either before or after surgery, by angioplasty. The rib resection alone is not adequate in our limited experience due to scarring and synechiae; ie, the surgery relieves the external compression but does nothing for the luminal scar and webs. One case in which the patient had no improvement after surgery had such thick webs that the only way to get a guidewire across was to use a Rosch-Uchida catheter/needle (from the TIPS set) to puncture through the webs. This was followed by angioplasty with good long term results.