Axillo-subclavian venous thrombosis due to venous thoracic outlet syndrome: experience at a Chilean center (2000-2025)

Abstract

Introduction

: Axillo-subclavian venous thrombosis (ASVT) is a complication of venous thoracic outlet syndrome (vTOS).

Objective

: To describe our 25 years of experience in the endovascular and surgical management of ASVT.

Materials and Methods

: Retrospective, single-center analysis between 2000 and 2025 of sequential patients over 15 years of age with AVST. Patients who consulted for venous thrombosis lasting more than 30 days and/or those who underwent surgery at another center were excluded. Long-term functional disability was measured using the QuickDASH Score and UEFI-15 surveys.

Results

: Seventeen patients with ASVT were treated, with a mean age of 30.6±10.2 years^17-57, predominantly male (58.8%). They consulted for edema (100%) and pain (88.2%) in the affected limb. The diagnosis was confirmed by Doppler ultrasound (58.8%), venous angiography (23.5%), or both (17.6%). All patients were started on intravenous heparin at therapeutic doses. They then underwent catheter-directed thrombolysis (35.3%), pharmacomechanical thrombectomy (35.3%), or mechanical thrombectomy alone (29.4%), followed by venous angioplasty in 16 patients (94.1%), without stent placement. Finally, resection of the first rib and vein release were performed in 16 patients (94.1%). The median time between symptom onset and endovascular treatment was 10 days^1-30, and between endovascular treatment and first rib resection was 9 days^2-150. The most frequent postoperative complication was pneumothorax in 2 cases. The average follow-up was 51.5 months^1-110. Seventy-point-six percent were asymptomatic, and 29.4% presented with pain and mild edema, with a new ASVT diagnosed in two cases (13.3%). One of these cases corresponded to a patient who refused rib resection, and the other to a patient who did not undergo angioplasty after thrombolysis. One patient underwent reoperation 32 months after rib resection due to recurrence of symptoms. In the assessment of functional disability, 81.3% had no disability.

Conclusion

: In our experience, the management of ASVT is based on a combination of anticoagulation, endovascular procedures with angioplasty, and the need for subsequent decompression surgery.