PERSONAL EXPERIENCE: 5 Patients in three years (3 males, 2 females, ages 16-44) All underwent duplex U/S and Venography All required lysis with tPA and mechanical thrombectomy with Angiojet Placed on heparin/coumadin for 4-6 weeks Four returned for transaxillary first rib resection One patient reclotted vein while on anti-coagulation and was managed conservatively Other four patients had full resolution of symptoms No major post-op complications