Results (Table 1)
Twenty-six underwent surgical decompression for venous obstruction over a fifteen-year time period (2005 – 2020) and Eleven (42%) were female with 15 (58%) male. Median range for length of time of symptoms was 4 (2-30) days whilst length of time of TPA lysis was 22 (6-46) hours. One patient had a free floating first rib and three others had bony abnormalities related to the medial clavicle and costoclavicular junction (figures 5,6,7&8). Three (12%) had no intraluminal clot on initial Duplex ultrasonography and did not receive thrombolysis. Of the 23 (88%) receiving lysis all underwent decompression surgically. Twelve (46%) underwent surgery by the IC approach with 9 (35%) by the TA route. Four (15%) underwent a PC approach and one by the SC route. Of the 23 who underwent lysis, 16 (72%) had a tight stenosis in the SV at the medial aspect of the first rib. Furthermore, 2 of these stenoses were greater than 2cm in length. A further 3 were found to have a moderate SV stenosis after lysis and the remaining one an occlusion which was resistant to dilatation. Eleven venoplasties of the SV were performed - 5 prior to surgical decompression and 6 post. Follow up was for a median (range) of 36 (7-168) months and all 26 remained asymptomatic clinically with no evidence of post thrombotic sequelae in the affected arm.