Anatomy and Pathophysiology of VTOS

Acute axillosubclavian vein thrombosis is a disorder of the anterior thoracic outlet, and is always associated with an abnormally lateral insertion of the costoclavicular ligament. This is a low pressure system associated with extrinsic compressive forces, and conventional intraluminal therapy designed to treat atherosclerotic arterial lesions is not appropriate in this situation. In our experience of over 600 extremities with this condition, prompt thrombolysis followed by thoracic outlet decompression leads to excellent results in over 95 % of patients, especially if treatment is instituted soon after thrombosis occurs.