Fibrinolytic therapy for idiopathic subclavian-axillary vein thrombosis

Article Abstract:

Thrombosis is an abnormal condition in which clotting elements and cell debris accumulate and attach to a point on the interior wall of the vein. In healthy individuals, this rarely occurs in the subclavian-axillary vein (in the area of the collar bone and draining the veins of the arm). This is often considered a form of thoracic outlet syndrome, a type of nerve pathology causing ''pins and needles'' sensation in the fingers. Use of streptokinase, a plasminogen activator, to break up fibrin clots has been successful in treating venous thrombosis in selected cases. Eight previously healthy men ages 19 to 50, who had venous thrombosis of the subclavian-axillary vein, were treated in a community hospital. In seven patients treatment was begun within one week of onset of symptoms. All except one patient had a history of strenuous exertion or excessive stretching of the affected arm. Diagnosis was confirmed using venography (X-ray study of the veins). Patients were treated with intravenous infusions of streptokinase and were monitored in the intensive care unit. The goal of therapy is to treat the thrombosis and avoid complications of post-phlebitic syndrome. One of the eight patients developed rethrombosis and developed mild symptoms of post-phlebitic syndrome. On follow-up of up to five years, no patients had symptoms of post-phlebitic syndrome. In a related editorial comment, the excellent results of the study are noted and it is suggested that if the diagnosis of venous thrombosis secondary to external compression can be made, they this form of treatment would be indicated. Good results depend on early diagnosis and treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Drug therapy, Thrombosis, Fibrinolytic agents, Thrombolytic drugs, Blood circulation disorders, Vascular diseases, Streptokinase

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Combined transluminal angioplasty and infrainguinal reconstruction in multilevel atherosclerotic disease

Article Abstract:

A new and widely used tool in the treatment of peripheral vascular disease is transluminal angioplasty. In this procedure, a balloon-tipped catheter is threaded through the occluded (blocked) vessel to the point of obstruction; the balloon tip is then inflated and deflated several times, which splits the abnormal mass of fat or lipid, flattening the plaque against the artery wall and reopening the vessel. It is not clear if use of this procedure is beneficial for patients who have multilevel atherosclerotic disease. A retrospective study was undertaken of 46 patients with multilevel atherosclerotic disease who underwent both iliac (a vessel in the groin) transluminal angioplasty and reconstructive surgery to improve the outflow of blood into the leg. The average age of the patients was 62. These patients had other associated health problems including coronary artery disease (67 percent), hypertension (61 percent), and diabetes mellitus (42 percent); 80 percent of all patients were smokers. There were no deaths and four complications (graft infection, heart attack, and wound infections). Follow-up ranged from 1 month to 10 years (average of 27.3 months): eight patients required another operation to save the leg, and five patients required amputation due to graft clot formation or failure. There was no indication that the angioplasty caused graft failure. Life-table analysis showed a five-year primary patency rate of 72 percent and a five-year limb salvage rate of 93 percent. It is concluded that this combined procedure is both safe and effective in treating patients with multilevel atherosclerotic disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Peripheral vascular diseases, Atherosclerosis, Iliac artery

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Percutaneous transluminal angioplasty versus surgery for subclavian artery occlusive disease

Article Abstract:

Narrowing of the subclavian artery (the major artery below the collarbone that brings blood to the arm) may either be without symptoms or may cause symptoms of ischemia (decreased blood supply, often characterized by pain and dysfunction) of the brain or arm. Treatment may be by surgery, in which the subclavian vein is revascularized using a bypass. An alternative treatment is the use of percutaneous transluminal angioplasty (PTA). PTA uses a balloon-tipped catheter which is threaded through the occluded vessel to the point where it is obstructed by atherosclerotic plaque; the balloon tip is then inflated and deflated several times, thus flattening the plaque against the artery wall and reopening the artery. A study was undertaken to compare patients who underwent surgery with those who underwent PTA. These patients were specifically selected (all were eligible to be treated with either PTA or surgery) and thus represent a minority of patients with subclavian occlusive disease. There were 21 patients treated with PTA and 15 who underwent surgical reconstruction. Average follow-up after PTA was 30 months, and after surgery, follow-up averaged 40 months. Complications were similar in both groups. The PTA-treated patients had better early results, however there was a continuous deterioration of blood flow through the artery which led to a high rate of recurrence of the blockage. The five- year rates of patency (openness of the vessel, allowing for blood flow) were 54 percent for PTA and 87 percent for surgery. It is concluded that long-term patency is better following surgery. (Consumer Summary produced by Reliance Medical Information, Inc.)

Arterial occlusions, Arterial occlusive diseases, Vascular grafts

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