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subclavian/innominate DVT
Hello,

I am a 30 yr old male, non-smoker, previously healthy, only significant medical history is spontaneous pneumothorax which was fixed 7 yrs ago. My question relates to treatment for chronic DVT. I suffered an acute rt arm DVT in Nov. 06 which was removed by catheter-directed tPA. I was diagnosed with venous thoracic outlet syndrome. In Feb. 07 I reported to a referral surgeon to investigate my candidacy for rib resection, however, at this referral the surgeon suspected I had suffered another DVT and sent me for an emergency CT. This showed I had a large, non-occlusive thrombus in the RT innominate vein. My vasc. surgeon declined thrombolysis, as he suspected the DVT was 3 wks old based on clinical history and outside the window of efficacy. I have been recently referred again to the thoracic outlet specialist to look at my condition and he doesn't think that anything can be done to resolve the innominate DVT (about 2 cm). He also doesn't think that there is a point to rib resection. My current symptoms are slight arm swelling that worsens with any exertion, visible collaterals, jugular tightness with activity, slight tingling in fingers, and arm fatigue.

I have been examining options, such as vein reconstruction/bypass.

My questions are:

1. If a surgeon elected for a vein reconstruction, how disabling is the sternotomy surgery?

2. Are there any effective intraluminal/endovenous techniques to resolve the thrombus?

3. Can you suggest any effective treatment for this condition?
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