# Subclavian Vein Thrombosis in a Patient With Venous Thoracic Outlet Syndrome and Previous Preventive First Rib Resection

## TL;DR

A 33-year-old woman with a history of rib resection developed subclavian vein thrombosis and was successfully treated with endovascular thrombectomy.

## Contribution

This case highlights successful endovascular treatment for subclavian vein thrombosis following rib resection for thoracic outlet syndrome.

## Key findings

- Endovascular thrombectomy successfully treated right subclavian vein thrombosis in a patient with prior rib resection.
- Venous collaterals formed as a compensatory mechanism following chronic subclavian vein injury.
- Anticoagulation duration and stent placement were considered in post-ribs resection management.

## Abstract

Deep vein thrombosis (DVT) associated with venous thoracic outlet syndrome (vTOS) after rib resection is rare. In younger, physically active people, repetitive upper extremity activity can lead to effort thrombosis (Paget-Schroetter syndrome), as the subclavian vein is chronically injured and becomes fibrotic. Without restored patency, venous collaterals form as a compensatory mechanism to overcome chronic occlusion.

We report a successful mini-invasive endovascular thrombectomy for right subclavian vein thrombosis in a 33-year-old female patient with bilateral first rib resection performed at another hospital 10 years prior, which was performed as a secondary thrombosis prevention on the left side and as primary thrombosis prevention on the right, non-acutely thrombosed side.

We discuss key therapeutic aspects, including anticoagulation duration, need for reintervention, and indication for stent placement after rib resection.