J. Ernesto Molina, MD, PhD, David W. Hunter, MD, Charles A. Dietz, MD

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Paget-Schroetter syndrome treated with thrombolytics and immediate surgery J. Ernesto Molina, MD, PhD, David W. Hunter, MD, Charles A. Dietz, MD Journal of Vascular Surgery Volume 45, Issue 2, Pages 328-334 (February 2007) DOI: 10.1016/j.jvs.2006.09.052 Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 1 The fibrous stricture of the subclavian vein is clearly visualized after 1 hour of thrombolytic therapy. Journal of Vascular Surgery 2007 45, 328-334DOI: (10.1016/j.jvs.2006.09.052) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 2 With the subclavian vein freed and fully mobilized, an incision (arrows) is placed across the stricture, extending medially into the normal innominate vein. Journal of Vascular Surgery 2007 45, 328-334DOI: (10.1016/j.jvs.2006.09.052) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 3 All of the organized fibrotic material causing the obstruction is removed before placement of the venous patch. Journal of Vascular Surgery 2007 45, 328-334DOI: (10.1016/j.jvs.2006.09.052) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 4 The saphenous vein patch is laid over the strictured segment of the vein. Journal of Vascular Surgery 2007 45, 328-334DOI: (10.1016/j.jvs.2006.09.052) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 5 Drawing shows the transmanubrial extension of the subclavicular incision to the center of the sternum and vertically up to the sternal notch. This exposes the entire subclavian (Scl) and innominate vein without a need to remove or divide the clavicle. Journal of Vascular Surgery 2007 45, 328-334DOI: (10.1016/j.jvs.2006.09.052) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions

Fig 6 The key to success is the complete mobilization of the subclavian vein, detaching it anteriorly from the sternum (arrow) until the vein is easily exposed in the operative field, allowing sufficient margin for placement of the medial clamp between the site of the stricture and normal innominate vein. Journal of Vascular Surgery 2007 45, 328-334DOI: (10.1016/j.jvs.2006.09.052) Copyright © 2007 The Society for Vascular Surgery Terms and Conditions