Open central venous reconstruction: technique, advantages, and pitfalls of partial sternotomy with infraclavicular resection of the first rib.

The traditional approach for open reconstruction of the obstructed subclavian vein has been through disarticulation or partial removal of the clavicle. Partial or full sternotomy has been used for innominate vein or superior vena cava reconstructions. Each approach has its inherent limitations with regard to optimal exposure and may be associated with morbidity. Herein we report the case of a 33-year-old man with chronic central venous occlusion, who underwent a right axillary-superior vena cava bypass using the femoral vein via partial sternotomy with infraclavicular resection of the first rib. Early, minor revision of the graft was required, but the patient had a successful clinical outcome 1 year after surgery. Techniques, advantages, and pitfalls of such reconstructions are discussed in this case report.