Thrombolysis and infraclavicular first rib resection for primary subclavian venous thrombosis – results from a population-based strategy

Introduction Primary subclavian venous thrombosis (PSVT), affects young patients with an active lifestyle or strenuous occupations. Treated with anticoagulation alone, up to 45% develop post-thrombotic syndrome (PTS). Early treatment with catheter-directed thrombolysis (CDT) followed by first rib resection (FRR) has been shown to reduce PTS in selected cases. We report outcomes when this treatment is implemented in a regional population. Method Patients with PSVT presenting within 14 days from symptom onset were treated between 2013 and 2024, and followed by clinical visits and duplex ultrasound 1 and 12 months after surgery. Primary outcome was Disabilities of the Arm, Shoulder and Hand (DASH) score and secondary outcome was clinical result according to the Derkash classification. Ethical approval was obtained from the Regional Ethics Board. Result 227 patients underwent CDT and FRR, with a median age of 30, (IQR 25-40 years) and 51% were women (n=116). Regular sport activity was performed by 70% (156/227). The median time from symptom onset to start of CDT was six (IQR 4-8) days. 197 patients completed 12 months follow-up. Median DASH-score at baseline was 30 (IQR 13-45) and decreased to 1 (IQR 0-6) at 12 months follow-up. Outcome at 12 months according to the Derkash classification was excellent or good in 98% (n=194/197). Discussion Early CDT and FFR in acute PSVT yields good results when implemented at a population level. This study supports that most patients with PSVT in a population can be identified early and offered treatment with early CDT and FFR to avoid PTS.