Surgical Techniques: Operative Decompression Using the Infraclavicular Approach for VTOS with Intraoperative Venography

The infraclavicular approach provides direct access to the costoclavicular space for focused treatment of VTOS. Using this approach anterior first rib resection and subclavian venolysis can be performed within the same procedure without unnecessary exposure or manipulation of the brachial plexus or subclavian artery. Additionally, sacrifice of collateral veins that usually exist in the supraclavicular and axillary areas is easily avoided. Finally, the infraclavicular approach provides excellent exposure for surgical reconstruction of the subclavian vein with either patch angioplasty or interposition bypass grafting if required. This approach offeres excellent technical and clinical results as have been reported by multiple groups.