Ereoperative thrombolysis and venoplasty affords no benefit in patency following first rib resection and scalenectomy
for subacute and chronic subclavian vein thrombosis.
Stoney, "Supraclavicular radical scalenectomy
and transaxillary first rib resection for the thoracic outlet syndrome.
All patients underwent anterior scalenectomy
. If a cervical rib was present, it was resected.
A week later he returned to the hospital and had right first rib removal, complete anterior and middle scalenectomy, mobilization and protection of the brachial plexus with external neurolysis of C5-T1 roots, and external venolysis of the left subclavian vein (Figures 4 and 5).
Thrombolytic therapy is usually tried by catheter infusion of alteplase in the vein itself [7, 8], while decompression of the thoracic outlet by first or cervical rib resection, division of anomalous musculotendinous bands, and scalenectomy remain the ultimate treatment [7, 8].
Their treatment included thoracic outlet decompression via complete anterior and middle scalenectomy
, brachial plexus neurolysis, excision of subclavius muscle tendon, and resection of the first rib.
Two case studies evaluated treatment of UEVT with thrombolytic therapy followed by various surgical interventions (angioplasty, thrombectomy, decompression via first rib resection or anterior scalenectomy
, and venous bypass).
It usually involves a scalenectomy
and removal of the first rib.
Consultation of the surgical literature confirms that scalenus anterior lies deep to the clavicular head of SCM, and gives further insight: Mattson (2004) in an article on the surgical approach to anterior scalenectomy
clearly describes how the surgeon must progress through the skin, platysma, the clavicular head of SCM and a fat pad before scalenus anterior becomes visible.