Bilateral nonthrombotic subclavian vein obstruction causing upper extremity venous claudication

Venous complications of thoracic outlet obstruction are frequently the result of acute axillosubclavian vein thrombosis, leading to symptoms consistent with venous claudication, including pain, swelling, and cyanotic discoloration. Nonthrombotic subclavian vein obstruction, however, is an uncommon cause of veno-occlusive symptoms. We report the case of a patient who, while running, developed pain consistent with venous claudication in her left arm and subsequently in her right arm. Clinical and hemodynamic evaluation revealed nonthrombotic subclavian vein obstruction, which was relieved by thoracic outlet decompression following first rib resection.