Reoperations after failed transaxillary first rib resection to treat paget-schroetter syndrome patients

Background: A series of 15 patients previously treated for Paget-Schroetter syndrome with a transaxillary first rib resection (TARR) were seen with recurrent thrombosis. Methods: Ten were reoperated using an anterior subclavicular approach. The time of reoperation ranged from 5 months to 7 years (mean, 23.4 months). All patients had been subjected to multiple balloon plasties and 4 of them in addition had up to 3 stents implanted, which also failed. Reevaluation was done with venography. Ten patients were considered to be still salvageable and were reoperated, but 5 were inoperable due to progressive obliteration of the venous channel as early as 2 weeks after TARR. Results: All 10 patients had successful reestablishment of the subclavian vein patency and caliber and have remained patent without anticoagulants. Conclusions: The patients who re-thrombose or remain obstructed after TARR should be reoperated instead of resourcing to implanting stents or multiple balloon plasties that invariably fail, and patients should not be kept on anticoagulation indefinitely hoping to maintain the vein open.