Mechanical suction thrombectomy for venous thrombosis in venous thoracic outlet syndrome in the pediatric population.

Venous thoracic outlet syndrome (vTOS) complicated by deep venous thrombosis (DVT) is rare in pediatric patients, and management is extrapolated from adult paradigms. Catheter-directed thrombolysis carries bleeding risk and logistical challenges. We present two pediatric cases of right-sided vTOS-associated axillosubclavian DVT successfully managed with endovascular mechanical suction thrombectomy. Both patients underwent right-sided venography followed by mechanical suction thrombectomy with restoration of inline venous flow. One patient with acute thrombosis achieved complete clot resolution, without surgical decompression. The second, with subacute thrombosis, underwent adjunctive balloon angioplasty with delayed first rib resection. This represents an effective thrombolysis-sparing endovascular strategy for vTOS-associated DVT. Clinical relevance: Mechanical suction thrombectomy may provide vascular surgeons with a safer, intensive care unit-sparing alternative to thrombolysis for managing pediatric venous thoracic outlet syndrome-associated deep venous thrombosis.