J ENDOVASC THER 2003;10:733–738 733  2003 by the INTERNATIONAL SOCIETY OF ENDOVASCULAR SPECIALISTS Available at www.jevt.org  RAPID COMMUNICATION  Treatment of Axillosubclavian Vein Thrombosis: A Novel Technique for Rapid Removal of Clot Using Low-Dose Thrombolysis Frank R. Arko, MD; Paul Cipriano, MD; Eugene Lee, MD, PhD; Konstantinos A. Filis, MD, PhD; Christopher K. Zarins, MD; and Thomas J. Fogarty, MD Division of Vascular Surgery, Stanford University Medical Center, Stanford University, Stanford, California, USA   Purpose: To report successful combined percutaneous mechanical thrombectomy and pharmacological lysis for axillosubclavian vein thrombosis, with rapid clot removal at a single setting using low-dose thrombolysis. Case Reports: Two consecutive patients presented with arm swelling; the diagnosis of axillosubclavian vein thrombosis was confirmed with duplex ultrasound. Both patients were treated percutaneously with the Solera mechanical thrombectomy device, after which 5 mg of tissue plasminogen activator were delivered within 10 minutes via the Trellis infusion catheter to remove any residual thrombus. Completion venography and serial duplex ultrasound scans in follow-up demonstrated widely patent axillosubclavian veins with no residual thrombus in both cases. Conclusions: Standard treatment of axillosubclavian vein thrombosis may require 12 to 36 hours, with multiple trips to the angiography suite. The novel technique combining me- chanical thrombectomy and pharmacological lysis can be performed safely and success- fully at a single setting with a small dose of the lytic drug. J Endovasc Ther 2003;10:733–738 Key words: axillosubclavian vein, upper extremity vein thrombosis, mechanical thrombec- tomy, thrombolysis, tissue plasminogen activator, Solera Bacchus Thrombectomy Cathe- ter, Trellis Infusion System   Address for correspondence and reprints: Frank R. Arko, MD, Director, Endovascular Surgery, Division of Vascular Surgery, 300 Pasteur Drive, H3600, Stanford, CA 94305 USA. Fax: 1-650-498-6044; E-mail: farko@stanford.edu Upper extremity deep vein thrombosis (DVT) can occur for a variety of reasons. Primary subclavian vein thrombosis, or Paget- Schroetter syndrome, usually affects young, active people and can lead to serious morbid- ity if not recognized and appropriately treat- ed. Primary objectives of treatment for Paget- Schroetter syndrome include relief of venous obstruction and prevention of recurrent thrombosis with correction of any underlying anatomical abnormality associated with tho- racic outlet syndrome, which typically in- volves thrombolytic therapy to restore paten- cy followed by first rib resection. 1,2 Secondary development of axillosubclavian thrombosis typically is associated with long-standing placement of central venous catheters. Regardless of etiology, thrombolysis is of- ten successful in removing acute thrombus, restoring patency, and relieving venous hy- pertension in patients with axillosubclavian vein thrombosis. Usually, the arm swelling associated with this condition is improved as well. However, significant bleeding complica-