Axillo-subclavian venous thrombosis due to venous thoracic outlet syndrome: experience at a Chilean center (2000-2025)

• Retrospective single-center study of 17 patients with axillo-subclavian vein thrombosis due to venous thoracic outlet syndrome (2000–2025). • All patients received anticoagulation plus catheter-directed or mechanical thrombectomy, followed by venous angioplasty in 94%. • First rib resection with venous release was performed in 94% of patients. • At mean follow-up of 51.5 months, 81% had no disability, 71% were asymptomatic, and recurrence occurred only without angioplasty or rib resection. : Axillo-subclavian venous thrombosis (ASVT) is a complication of venous thoracic outlet syndrome (vTOS). : To describe our 25 years of experience in the endovascular and surgical management of ASVT. : Retrospective, single-center analysis between 2000 and 2025 of sequential patients over 15 years of age with AVST. Patients who consulted for venous thrombosis lasting more than 30 days and/or those who underwent surgery at another center were excluded. Long-term functional disability was measured using the QuickDASH Score and UEFI-15 surveys. : Seventeen patients with ASVT were treated, with a mean age of 30.6±10.2 years 17-57 , predominantly male (58.8%). They consulted for edema (100%) and pain (88.2%) in the affected limb. The diagnosis was confirmed by Doppler ultrasound (58.8%), venous angiography (23.5%), or both (17.6%). All patients were started on intravenous heparin at therapeutic doses. They then underwent catheter-directed thrombolysis (35.3%), pharmacomechanical thrombectomy (35.3%), or mechanical thrombectomy alone (29.4%), followed by venous angioplasty in 16 patients (94.1%), without stent placement. Finally, resection of the first rib and vein release were performed in 16 patients (94.1%). The median time between symptom onset and endovascular treatment was 10 days 1-30 , and between endovascular treatment and first rib resection was 9 days 2-150 . The most frequent postoperative complication was pneumothorax in 2 cases. The average follow-up was 51.5 months 1-110 . Seventy-point-six percent were asymptomatic, and 29.4% presented with pain and mild edema, with a new ASVT diagnosed in two cases (13.3%). One of these cases corresponded to a patient who refused rib resection, and the other to a patient who did not undergo angioplasty after thrombolysis. One patient underwent reoperation 32 months after rib resection due to recurrence of symptoms. In the assessment of functional disability, 81.3% had no disability. : In our experience, the management of ASVT is based on a combination of anticoagulation, endovascular procedures with angioplasty, and the need for subsequent decompression surgery.