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Findings: Left arm venogram demonstrates complete occlusion of the subclavian and innominate veins. Multiple collaterals are visualized extending inferiorly from the axilla and across the shoulder and back to the right side of the neck. The largest involves the superior intercostal vein.

Diagnosis: Complete occlusion of the left subclavian and innominate vein with multiple collaterals suggesting this to be a chronic occlusion.

Discussion: Those patients who have had access catheters placed on the side of a proposed AV graft, a venogram should be performed prior to surgery. Edema of the upper extremity from venous insufficiency is the most common manifestation of axillary, subclavian innominate or superior vena cava obstruction. The traditional cause for thrombosis include tumors, mediastinal fibrosis and trauma. An increasing number of thromboses are secondary to indwelling catheters.

References:

1. Baum S. Abram's Angiography, Vascular and Interventional Radiology,
   4th Edition. Little Brown and Company, New York 1997; 2(70):1775-1777.

2. Lazar LJ. Principles of Surgery, 6th Edition. McGraw-Hill Inc.,
   New York 1994; 1(21):997.