[Subclavian vein thrombosis: medical treatment].

Thromboses of the subclavian vein are rare. However there is a higher incidence due to the increasing use of central venous catheters and pacemakers. Thoracic outlet syndrome is no longer the main cause. Thromboses may be clinically apparent, however when they are caused by the insertion of a catheter, thromboses may be symptom-free. Phlebography is the gold standard for the diagnosis. B mode ultra-sounds may give false results in that particular location. The optimum treatment of subclavian thromboses should prevent the occurrence of pulmonary embolisms, and the development of post-thrombotic syndrome. Heparin followed by anti-vitamin K meets these two objectives in the majority of cases. The risks of thrombolytic therapy is, in our opinion, unacceptable to promote thrombolysis to treat upper limb venous thrombosis. Surgery is indicated in cases of phlematia caerulea which are extremely rare, and in cases of septic thrombosis. The preventive treatment of the opposite side of a symptomatic thoracic outlet syndrome, is questionable, except in the case where the findings of the clinical examination, B mode ultrasound and phlebography results, are in favor of a intermittent compression of the vein with a risk of thrombosis.