Druy E M, Trout H H, Giordano J M, Hix W R
J Vasc Surg. 1985 Nov;2(6):821-7.
The importance of individualized treatment of patients with primary and secondary axillary-subclavian vein thrombosis is described with special emphasis on the use of thrombolytic therapy. Nine patients were treated with streptokinase or urokinase. Balloon dilation of the axillary or subclavian vein and first rib resection were also selectively used. Of the five patients with primary axillary-subclavian thrombosis, three did not have symptoms after the thrombus was lysed. Two had successful lysis of the thrombus but later suffered a rethrombosis, one of which most likely resulted from an untreated stenosis. All four of the patients with secondary thrombosis had successful thrombolysis. Patients with primary axillary-subclavian thrombosis are usually young and as many as 40% continue to have intermittent upper extremity edema or pain. For this reason we believe aggressive attempts to reestablish normal venous return through the axillary and subclavian veins are warranted. Patients with secondary axillary-subclavian thrombosis usually require prolonged venous catheterization for chemotherapy or total parenteral nutrition. Since patency of major upper extremity veins is extremely important in these patients with secondary thrombosis, we believe that vigorous attempts to restore these venous access routes are indicated and appropriate.
阐述了原发性和继发性腋-锁骨下静脉血栓形成患者个体化治疗的重要性，特别强调了溶栓治疗的应用。9例患者接受了链激酶或尿激酶治疗。还选择性地采用了腋静脉或锁骨下静脉球囊扩张术及第一肋切除术。5例原发性腋-锁骨下静脉血栓形成患者中，3例血栓溶解后无症状。2例血栓成功溶解，但随后再次发生血栓形成，其中1例很可能是由于未治疗的狭窄所致。4例继发性血栓形成患者均成功进行了溶栓治疗。原发性腋-锁骨下静脉血栓形成患者通常较年轻，多达40%的患者持续存在间歇性上肢水肿或疼痛。因此，我们认为有必要积极尝试通过腋静脉和锁骨下静脉重建正常的静脉回流。继发性腋-锁骨下静脉血栓形成患者通常需要长期进行静脉置管以进行化疗或全胃肠外营养。由于在这些继发性血栓形成患者中，主要上肢静脉的通畅极为重要，我们认为积极尝试恢复这些静脉通路是必要且合适的。
