In Reply to: Case 0298_10 --Mechanical thrombolysis for effort vein thrombosis posted by Editor on February 03, 1998 at 11:52:28:
I encourage everyone to read Machleder et al JVS 1993; 17:305-317, which is the landmark article in this area. They reported 50 cases or primary axillosubclavian thrombosis treated with thrombolysis followed by surgical correction of the extrinsic compression (rib/clavicle). PTA was ONLY used when there was residual stenosis after surgery (9 cases, successful in 7). This overall approach yielded 93% patency at mean 3.1 y followup.
Most authors indicate that PTA should be avoided in these cases to limit trauma to the vein. Thrombolysis is absolutely indicated, and it may very well be that mechanical lysis possibly with some UK added is the way to go.
Given the excellent results with combined surgical and lytic therapy and the complete lack of data about stents in this disease process I would avoid them at all cost, only using them as a last resort after surgery has failed, and then only if the extrinsic lesion was repaired. Otherwise any stent there will fracture in the long term (see Venous Interventions syllabus p175).