Figure 1

The axillary-subclavian vein is located under the arm and extends across the shoulder, under the clavicle, and into the lower neck (Figure 1). The axillary vein actually becomes the subclavian vein as it passes into the space between the first rib and the clavicle. Acute thrombosis (formation of a stationary blood clot) in the axillary and subclavian veins is uncommon and occurs in less than 4% of all deep vein thromboses. As with any deep vein thrombosis, local symptoms may occur (swelling, pain especially with exercise, bluish discoloration, etc.) in addition to the possibility of a pulmonary embolus (blood clot traveling to the lungs).

Figure 1. The axillary vein becomes the subclavian vein at the outer border of the first rib, and the internal jugular vein joins it in the base of the neck to become the innominate vein. (Awaiting permissions for the modification from DeWeese JA. Management of subclavian venous obstruction. In Bergan JJ, Yao JST, eds. Surgery of the Veins. New York: Grune & Stratton, 1985;26:365-372.)

People with axillary-subclavian venous thrombosis usually have swelling of the affected arm with distended, prominent veins in the hand and forearm and prominent veins along the chest. Other possible signs are bluish discoloration and a tender prominent cord in the arm, axilla (armpit), or neck. Occasional tingling or numbness of the arm and hand may be due to the pressure of edema (accumulation of fluid) rather than nerve damage.

Many patients have arm tightness or aching pain that grows worse with exercise (called effort thrombosis). This condition occurs mostly in young active men with a history of repetitive strenuous exercise as in sports and manual labor.