Deep Venous Thrombosis - Thoracic Outlet Syndrome

  I am 28 year old male with a history of thrombosis in the right subclavean vein. The thrombosis has been attributed to thoracic outlet syndrome. The first case of thrombosis was found when I was 18 years old. Symptons included pain, swelling, discoloration tingling in the fingers etc.. At the time I was put on a Heparin drip which eventually led to coumadin (warfarin) daily for a number of years. After stoppping the coumadin (2 years later) everything seemed fine until aproximately 6 months later when there was a reoccurence of the clotting. I have had similar problems every time I go off the coumadin. In my last episode clotting did not occur until I was off the Coumadin for almost 4 years. I was participating in more sports and trying to get back into shape.
  The clotting has reoccurred 4 or 5 times over the last 10 years and my Vascular Surgeon has reluctantly suggested that the only thing left to try is a Thoracic Outlet Decompression Surgery. I am obviously reluctant to go under the knife but I do wish to eventually lead a normal life again. I really don't want to be on coumadin for the rest of my life.
  No cervical rib was ever found. It is assumed that a sports injury about the time of the first thrombosis has shifted the position of the first rib.  If there is any other information required please ask. I have been dealing with this for almost 10 years so there is always something I may forget to mention.
Dear Robert:
Sorry to hear about your problem.  I am assuming that you have had all the tests to rule out a hypercoaguable state (Protein C and S deficiency, Leiden factor, anticardiolipin antibodies, etc).  I am also assuming that anti-platelet therapy, with some of the newer agents like Plavox, is not an option.  It sounds like your only option at this point is surgery.  However, the bright side of things is that once surgery corrects the problem, you can get on with your life.  Best of luck, sorry I couldn't be more helpful.
Sincerely,
CCF Neuro[P] MD