Nous avons observé dans notre service, 2 épisodes de thrombophlébitesaxillo-sous-clavières récidivantes et persistantes, chez 2 patients, d'étiologieextrinsèque (Paget-Schroetler syndrome). Nous avons entrepris dans ces 2 cas untraitement médical conventionnel bien conduit par fibrinolyse et/ou anticoagulation àposologie efficace. Devant la persistance des symptômes et de la thrombose veineuse, uneprise en charge chirurgicale a été effectuée, et devant le remaniement veineuxpariétal, une reconstruction par décompression et transposition de la veine jugulaireinterne homolatérale et fistule artério-veineuse temporaire a été nécessaire,permettant d'obtenir secondairement une récupération clinique totale et une parfaiteperméabilité veineuse du membre supérieur à court et moyen terme.

Indications for treating subclavian vein obstruction are still being developed,especially for endovascular procedures with or without first rib resection. This articleexplores our experience with chronic and acute subclavian vein thrombosis persisting aftermedical treatment.

In our department of vascular surgery, we have observed 2 cases of subclavian veinobstruction in 2 patients with Paget-Schroetler syndrome who developed major pain andedema in the dominant upper limb. Initially, we managed these patients medically withthrombolysis and anticoagulation. Then, as the significant symptoms persisted and venousthrombolysis developed, we decided on surgical treatment. Because of hypertrophic venousimpairment, we used an aggressive procedure with venous bypass using jugular veintransposition and temporary arteriovenous fistula. We observed significant symptom reliefand also perfect permeability of the venous bypass at 30 months.

Conclusion: On the basis of our anecdotal experience and reports by other groups,aggressive treatment with decompression (first rib resection and scalenectomy) and jugularvein transposition could be recommended for persistent subclavian vein thrombosis. Becauseof the presence of a thoraco-brachial outlet syndrome the endovascular procedures shouldbe completed by first rib resection.