Treatment of Axillosubclavian Vein Thrombosis: A Novel Technique for Rapid Removal of Clot Using Low-Dose Thrombolysis

Author:

Arko Frank R.1,Cipriano Paul1,Lee Eugene1,Filis Konstantinos A.1,Zarins Christopher K.1,Fogarty Thomas J.1

Affiliation:

1. Division of Vascular Surgery, Stanford University Medical Center, Stanford University, Stanford, California, USA

Abstract

Purpose: To report successful combined percutaneous mechanical thrombectomy and pharmacological lysis for axillosubclavian vein thrombosis, with rapid clot removal at a single setting using low-dose thrombolysis. Case Reports: Two consecutive patients presented with arm swelling; the diagnosis of axillosubclavian vein thrombosis was confirmed with duplex ultrasound. Both patients were treated percutaneously with the Solera mechanical thrombectomy device, after which 5 mg of tissue plasminogen activator were delivered within ∼10 minutes via the Trellis infusion catheter to remove any residual thrombus. Completion venography and serial duplex ultrasound scans in follow-up demonstrated widely patent axillosubclavian veins with no residual thrombus in both cases. Conclusions: Standard treatment of axillosubclavian vein thrombosis may require 12 to 36 hours, with multiple trips to the angiography suite. The novel technique combining mechanical thrombectomy and pharmacological lysis can be performed safely and successfully at a single setting with a small dose of the lytic drug.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Radiology Nuclear Medicine and imaging,Surgery

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