Ameli F M, Minas T, Weiss M, Provan J L
Can J Surg. 1987 May;30(3):167-9.
To evaluate the long-term effects of "conservative" management (heparin initially then Coumadin for 3 months) on patients with axillary vein thrombosis, the authors studied 20 patients (average age 44 years) who presented at the Wellesley Hospital in Toronto between 1975 and 1984. The diagnosis of axillary vein thrombosis was made from history, findings on physical examination and Doppler studies. In 12 patients, the diagnosis was confirmed by venography. Three patients subsequently underwent a first-rib resection for thoracic outlet syndrome. The average follow-up was 42 months. The cause of the thrombosis in 3 patients was an intravenous-line catheter, in 7 it was effort thrombosis and in 10 the cause was unknown. Two patients had had a previous deep venous thrombosis in the lower limb. Results of conservative treatment showed that only five patients had residual minimal swelling and two had minor discomfort. These symptoms did not interfere with either leisure or work activities in any of the patients. Fifteen patients were asymptomatic. One patient had nonfatal pulmonary embolism. The conservative management of axillary vein thrombosis is safe, effective, relatively inexpensive and gives excellent long-term results. The prognosis is good, irrespective of the cause of the thrombosis and, in view of this, a more aggressive approach, using either streptokinase therapy or thrombectomy, does not appear to be justified.
为评估“保守”治疗（最初使用肝素，随后使用香豆素3个月）对腋静脉血栓形成患者的长期影响，作者研究了1975年至1984年间在多伦多韦尔斯利医院就诊的20例患者（平均年龄44岁）。腋静脉血栓形成的诊断依据病史、体格检查结果及多普勒检查做出。12例患者经静脉造影确诊。3例患者随后因胸廓出口综合征接受了第一肋切除术。平均随访时间为42个月。3例患者血栓形成的原因是静脉导管，7例是努力性血栓形成，10例原因不明。2例患者既往有下肢深静脉血栓形成。保守治疗结果显示，仅5例患者有残留的轻微肿胀，2例有轻微不适。这些症状均未影响任何患者的休闲或工作活动。15例患者无症状。1例患者发生非致命性肺栓塞。腋静脉血栓形成的保守治疗安全、有效、相对便宜且长期效果良好。无论血栓形成的原因如何，预后均良好，鉴于此，采用链激酶治疗或血栓切除术等更积极的方法似乎没有道理。
