Changing strategies to treat venous thrombotic occlusions of the upper and lower extremities secondary to compressive phenomena.

OBJECTIVES We reviewed our strategies during the last decade for deep vein thrombosis (DVT) of the upper extremity due to thoracic outlet syndrome (TOS) andthe lower extremity. METHODS Between 1998 and 2011, we treated 31 patients with 18 subclavian DVTs and 13 iliac DVTs. Management included catheter-directed thrombolysis compared to mechanical thrombolysis (MT; post 2006). Prior to 2006, patients with TOS were treated with total excision of the first rib compared to excision of the anterior half of the rib. Patients were followed up with serial duplex ultrasounds. RESULTS There was no major morbidity and no mortality in these 31 patients. Three patients developed recurrent DVT but maintained patency after further treatment. CONCLUSION Use of MT has led to shorter treatment duration and length of hospital stay. Limiting first rib resection to the anterior half of the rib shortened operative time. Patients requiring stents had excellent long-term patency rates.