Surgical techniques: Operative decompression using the paraclavicular approach for venous thoracic outlet syndrome

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

2 Scopus citations


Following venography, thrombolysis and anticoagulation, comprehensive management of subclavian vein effort thrombosis due to venous TOS revolves around surgical treatment. Surgical treatment, in turn, involves first rib resection and various approaches to achieve a patent subclavian vein. The paraclavicular approach is one of several different strategies for thoracic outlet decompression, combining the advantages of supraclavicular and infraclavicular exposures, including complete resection of the first rib and direct reconstruction of the subclavian vein when needed. In this chapter we provide a detailed description of paraaclavicular decompression as a thorough, flexible, and safe approach to venous TOS. Special circumstances, potential complications and the reported results of treatment are briefly reviewed. This shows that following treatment with the paraclavicular approach, more than 90% of patients with venous TOS will have a patent subclavian vein, no arm swelling symptoms, normal function and no need for anticoagulation. We therefore believe that with expertise and experience, operative procedures based on paraclavicular exposure provide the most versatile, comprehensive, safe and successful approach to the treatment of venous TOS.

Original languageEnglish
Title of host publicationThoracic Outlet Syndrome
Subtitle of host publicationSecond Edition
PublisherSpringer International Publishing
Number of pages26
ISBN (Electronic)9783030550738
ISBN (Print)9783030550721
StatePublished - Jan 25 2021


  • Axillary-subclavian vein effort thrombosis
  • Intraoperative venography
  • Paget-Schroetter syndrome
  • Surgical techniques
  • Surgical treatment
  • Vein bypass graft
  • Vein patch angioplasty
  • Vein reconstruction
  • Venous thoracic outlet syndrome


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