Diagnosis and management of subclavian vein thrombosis: three case reports and review of literature.

Axillosubclavian vein thrombosis is seen relatively infrequently in clinical practice when compared with lower limb deep-venous thrombosis; however, it is a condition that can result in significant morbidity if managed suboptimally. A multimodal treatment approach has been increasingly adopted with thrombolysis and/or thoracic outlet decompression being favored over anticoagulation alone, although the evidence base to support this approach is limited. In all, 3 cases are reported, which highlight numerous pertinent issues relating to the diagnostic and therapeutic options available.

Routine beta-blockade in vascular surgery.

We have evaluated the safety and efficacy of routine beta-blockade for the prevention of cardiac complications in a comprehensive series of patients undergoing major vascular surgery and amputation for atherosclerotic arterial disease. From 1 December 2001 to 31 May 2002, patients received perioperative beta-blockade by atenolol. Outcomes in this period were compared to the immediately antecedent 6 months. The main outcome measure was the occurrence of cardiac complications. Fifty-three patients underwent surgery in the first period and 54 in the second. After introduction of routine beta-blockade, only one patient suffered cardiac complications compared to 10 in the first period (P=0.01). There were eight deaths in the first and two in the second period (P=0.052). On multivariate analysis, treatment with beta-blockers was the only variable significantly associated with a decrease in cardiac morbidity (OR=0.12; 95% CI=0.002-0.66; P=0.014). Two patients suffered bronchospasm leading to discontinuation of atenolol. Routine perioperative beta-blockade was safe and reduced the occurrence of cardiac complications after vascular surgery.