This is a 75 year old female with a history of significant left arm swelling of a chronic nature, with heaviness, tiredness, swelling, tingling of the left arm that developed after a port placement via the left subclavian approach for her breast cancer chemotherapy. The porta-cath was removed post-treatment. Following this, she developed significant swelling of the left arm with symptoms as mentioned. On physical exam. there was 5 cm circumferential differential between the left and the right arm, with left arm being larger. Ultrasound of the left arm suggested possible left axillary vein stenosis.
The patient had a venogram performed confirming occlusion of the left axillary and subclavian vein with extensive collateralization.
Endovascular recanalization of the left axillary and subclavian veins was performed with re-entry venogram, confirming intra-luminal position of the catheter. Multiple sequential angioplasties post, with less than optimal results, followed by stenting leading to excellent flow and results. Follow up demonstrated normalization of the left arm and resolution of the symptoms.
Picture 1, with axillary vein and subclavian occlusion with canalization.
Picture 2, recanalization with low profile balloon angioplasty.
Picture 3, large balloon angioplasty.
Picture 4, post venogram with diffuse residual elastic recoil of the left axillary and subclavian vein.
Picture 5, Post stent and angioplasty and venogram demonstrating good result.