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case_images: Presence of intramural thrombosis - Imaging techniques: A) Preoperative venography reveals the presence of intramural thrombosis along with extraluminal compression situated medially between the left clavicle and the first rib; B) Postoperative CTA incorporating venogram demonstrates a complete expansion of the subclavian vein observed five months after the surgical intervention.
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case_images: Venography confirmed presence of intramural thrombosis followed by extraluminal compression in the medial anatomical position between the left clavicle and the first rib (Figure 1A). A new CTA (Figure 1B) was performed in April 2023, which revealed the absence of intraluminal thrombosis and extraluminal vessel compression.
case_images: Collateral circulation in the region of the left shoulder: A) Prior to the surgical intervention, there is a marked presence of collateral circulation; B) Following the decompression of the left subclavian vein - there is the absence of collateral circulation.
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case_images: The examination revealed swelling in his left arm with light local heat and redness, and the superficial collateral veins were prominent (Figure 2A), but the radial pulse was normal. Moreover, throughout the follow-up, the patient did not encounter any additional episodes of venous thrombosis or limb swelling (Figure 2B).
case_images: Surgical steps of subclavian vein decompression: A) Subclavicular approach - the plan for the initial incision, focusing on the subclavian area. The subclavius muscle and the subclavian vein can usually be seen, along with other structures in this region. B) Evident hypertrophied subclavius muscle- a highlight of an enlarged or hypertrophied subclavius muscle. The muscle is likely to be noticeably larger than usual, possibly causing compression of adjacent structures, including the vein. C) Resection of the subclavius muscle - the hypertrophied subclavius muscle is being resected. This procedure is done to relieve pressure on the subclavian vein and other nearby structures. D) Fully expansion of the subclavian vein - this image shows the subclavian vein after the pressure has been relieved by the resection of the subclavius muscle. The vein is likely to be noticeably larger or more expanded as it is no longer being compressed by the muscle.
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case_images: The operation was performed through a subclavicular approach (Figure 3A), where the pectoralis major fibers were opened longitudinally. Subsequently, the hypertrophied subclavius muscle was identified and resected (Figure 3B and 3C). It was noted that the subclavius vein was expanded and completely decompressed (Figure 3D).