Reoperations After Failed Transaxillary First Rib Resection to Treat Paget-Schroetter Syndrome Patients J. Ernesto Molina, MD The Annals of Thoracic.

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Reoperations After Failed Transaxillary First Rib Resection to Treat Paget-Schroetter Syndrome Patients J. Ernesto Molina, MD The Annals of Thoracic Surgery Volume 91, Issue 6, Pages 1717-1721 (June 2011) DOI: 10.1016/j.athoracsur.2011.02.054 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Computed tomographic scan of the chest with tridimensional reconstruction after transaxillary removal of the first rib. It shows the presence of a significant residual first rib stump in the anterior and posterior portions (arrows). The Annals of Thoracic Surgery 2011 91, 1717-1721DOI: (10.1016/j.athoracsur.2011.02.054) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Patient no. 4. Venogram obtained after a transaxillary resection of the first rib showing the significant indentation and obstruction of the vein caused by the residual first rib stump under the subclavian vein (arrow). (B) Postoperative venogram obtained after the patient was reoperated through a subclavicular anterior approach with removal of the residual rib remnant as well as removal of the costoclavicular ligament and the subclavius tendon. The patient underwent patch angioplasty of the subclavian vein followed by placement of a stent. The Annals of Thoracic Surgery 2011 91, 1717-1721DOI: (10.1016/j.athoracsur.2011.02.054) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Patient no. 1. The results after transaxillary resection of the first rib followed by implant of two stents, both of which became obstructed. The venograms show clearly the kinking of the metal stent in the subclavian vein. (B) Results after the patient was reoperated through a subclavicular anterior approach with removal of the residual rib and the ligaments causing the obstruction of the vein. This operation required the implant of a new stent, which functioned quite well. The Annals of Thoracic Surgery 2011 91, 1717-1721DOI: (10.1016/j.athoracsur.2011.02.054) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Patient no. 10. Typical findings at time of reoperation after the left first rib had been removed using the transaxillary approach. First rib remnant measured 1 3/4 inches (dotted line between arrows). Intact subclavius tendon inserting on the rib (isolated arrows). Patient's sternum is on the left side of the photograph. (Pec: pectoralis major muscle; Vein: subclavian.) The Annals of Thoracic Surgery 2011 91, 1717-1721DOI: (10.1016/j.athoracsur.2011.02.054) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions