Claviculectomy for subclavian venous repair: Long-term functional results Richard M. Green, MD, David Waldman, MD, PhD, Kenneth Ouriel, MD, Patrick Riggs,

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Presentation transcript:

Claviculectomy for subclavian venous repair: Long-term functional results Richard M. Green, MD, David Waldman, MD, PhD, Kenneth Ouriel, MD, Patrick Riggs, MD, James A. DeWeese, MD Journal of Vascular Surgery Volume 32, Issue 2, Pages 315-321 (August 2000) DOI: 10.1067/mva.2000.106949 Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 A, Intrinsic lesion of the subclavian vein uncovered after thrombolysis of acute thrombus. There is an extensive collateral pattern that persists despite the resolution of a large volume of thrombus seen on pretreatment phlebogram (B). This patient's arm remained swollen and painful. Journal of Vascular Surgery 2000 32, 315-321DOI: (10.1067/mva.2000.106949) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 View of exposure after medial portion of clavicle is removed. The involved vein lies directly under the sternoclavicular joint. Dissection requires care because of the fragile network of collateral veins. Journal of Vascular Surgery 2000 32, 315-321DOI: (10.1067/mva.2000.106949) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 A postphlebitic web. This tissue can be excised, but if extensive, a bypass graft to normal vein is preferable. Journal of Vascular Surgery 2000 32, 315-321DOI: (10.1067/mva.2000.106949) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 A jugular venous bypass graft. The internal jugular vein can be mobilized craniad. Additional length can be obtained by mobilizing the sternomastoid muscle. The mobilized transected jugular vein is anastomosed to as normal an area as possible of the axillo-subclavian vein in an end-to-end fashion. Journal of Vascular Surgery 2000 32, 315-321DOI: (10.1067/mva.2000.106949) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Postoperative changes on duplex scan (A) led to venogram (B) , which did not reveal abnormalities. Basilic vein shows long narrowing due to postphlebitic changes. Journal of Vascular Surgery 2000 32, 315-321DOI: (10.1067/mva.2000.106949) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 6 Loss of contour to shoulder causes halter straps to slip down. This woman also had a prior shoulder procedure, and the combination, rather than the claviculectomy, may be the problem. Journal of Vascular Surgery 2000 32, 315-321DOI: (10.1067/mva.2000.106949) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions

Fig. 7 Appearance of cut end of distal clavicle after shoulder abduction and internal rotation. One patient complained of a clicking sensation with shoulder movement but no associated pain. Journal of Vascular Surgery 2000 32, 315-321DOI: (10.1067/mva.2000.106949) Copyright © 2000 Society for Vascular Surgery and The American Association for Vascular Surgery, a Chapter of the International Society for Cardiovascular Surgery Terms and Conditions