Figure 2.

Initial management of subclavian vein (SCV) effort thrombosis. Initial interventional management of a young man with right-sided SCV effort thrombosis. (A) Initial venogram confirming axillary-subclavian vein occlusion, with venous obstruction extending to the lateral chest wall. Very few collaterals are noted, compatible with acute obstruction. (B) Partial resolution of thrombus following catheter-directed thrombolytic therapy, clearing much of the axillary vein. (C) Restoration of axillary-subclavian vein patency with further thrombolytic therapy, revealing a residual high-grade stenosis in the SCV at the level of the first rib (arrow). (D) Inflation of an angioplasty balloon across the area of SCV stenosis, demonstrating the focal nature of the lesion as evidenced by effacement of the midportion of the balloon (arrow). (E) Successful inflation of the angioplasty balloon across the area of SCV stenosis. (F) Completion venogram demonstrating improved patency of the SCV with an area of persistent venous stenosis at the first rib (arrows).