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Regrowth Of First Rib Following Resection
Joanna F. Shaw, MD, Thomas Munro, Jesus G. Ulloa, MD, Hugh A. Gelabert, MD.
UCLA, Los Angeles, CA, USA.
DEMOGRAPHICS 40 year-old male with Paget-Schroetter syndrome (PSS) underwent infraclavicular left first rib resection and subclavian vein stent placement. He later presented with regrowth of his left first rib, resulting in compression and deformity of the left subclavian vein stent and required re-operative intervention.HISTORY After presenting with PSS, he underwent infraclavicular left first rib resection in 2020. At the same surgery he underwent open thrombectomy, vein repair with patch angioplasty and placement of a left subclavian stent. He was followed with annual venous duplex scans to assess patency of his stented subclavian vein.In May 2025 he presented with right side PSS and underwent transaxillary right first rib resection. During the course of evaluation, a CT venogram identified severe narrowing of his left subclavian vein stent due to regrowth of his left first rib. The stent narrowing had not been appreciated on previous duplex ultrasound which had been obtained 5 months before the CT scan. PLAN The regrowth of the left first rib was sufficient to deform and nearly occlude the subclavian stent, putting him at risk of stent thrombosis. We elected to perform transaxillary left first rib re-resection to decompress the stented subclavian vein, along with upper extremity venography to assess stent patency. Venograms following the re-operative decompression indicated the subclavian stent had resumed its essentially normal diameters with a slight focal irregularity, with intimal hyperplasia in the stent. As there was no flow-limiting stenosis, no further intervention was performed. DISCUSSION Re-growth of a first rib after resection is an uncommonly encountered clinical phenomenon. Compression of a subclavian vein stent by a re-grown rib is unreported. Re-operative surgery for PSS is technically challenging and should be approached with careful consideration. Axial imaging should be considered for patients with stented subclavian veins following first rib resection for PSS.
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