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Compression of the subclavian vein at the costoclavicular junction produces venous thoracic outlet syndrome. Prompt diagnosis and treatment is associated with the best results, but many patients present in a delayed fashion. Management of patients who present well after thrombosis consists of preoperative anticoagulation followed by surgical decompression in both symptomatic and asymptomatic patients. We perform a two-week post-operative venogram in order to document subclavian vein patency and if significant stenosis is revealed, a balloon venoplasty is performed. Most patients have some degree of patency at this time. Excellent outcomes have been achieved in long-term follow-up in these patients with one-year subclavian vein patency rates of approximately 90%. The need for postoperative documentation of subclavian vein patency is essential to ensuring positive long-term functional outcomes and improved quality of life.

Venous thoracic outlet syndrome is a disease process characterized by mechanical compression of the axillosubclavian vein as it exits the thoracic outlet. This chapter will review management considerations of venous thoracic outlet syndrome with respect to the efficacy of pre-operative thrombolysis. To date, clinical experience strongly favors surgical decompression of extrinsic compression of the subclavian-axillary vein, with adjunctive use of thrombolysis being a matter of some controversy.