[Intermittent compression of the subclavian vein]

The pathology of the cervico-thoracic channel is now well understood. Intermittent venous compression in the costo-clavicular space by the subclavian muscle can lead to acute occlusion of the venous trunk. It is important to make an early diagnosis of such compression before the stage of occlusive phlebitis. Clinical examination and dynamic phlebography allow the diagnosis to be made. Resection of the first rib is the ideal treatment. The mode of approach to the first rib is debatable since it seems that when venous symptomatology is dominant, the axillary method of Roos is not the best approach. A combined sub- and supra-clavicular approach permits a wide decompression of the vein and a more complete excision of the rib.