To the Editor.—The article by Landercasper et al1 may lead readers to the wrong conclusion that thrombosis of the axillary-subclavian vein can be treated successfully with systemic thrombolytic therapy, as used in the four cases described in the article. Although thrombolytic therapy has already been tried in this syndrome by several investigators, including me, the success of the treatment is limited to dissolution of the clots. However, the basic problem of extrinsic constriction of the vein and intimal tear is not solved by this therapy alone. The simultaneous use of anticoagulation and surgery has been proposed by several groups; however, Landercasper et al used these methods in sequence in two of their patients. Even the posttreatment venogram in the article shows a definite constriction of the vein at the level of the inner third of the clavicle. This has been the problem in all of these cases, and
MOLINA JE. Thrombolytic Therapy of Axillary-Subclavian Venous Thrombosis. Arch Surg. 1988;123(5):662. doi:10.1001/archsurg.1988.01400290148028
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