17 year old male recently admitted for a Left Subclavian DVT. Ultrasound showing an acute deep venous thrombosis involving the left subclavian and axillary veins. He underwent a MRA of the Chest showing thrombus in the left subclavian vein. He underwent catheter directed thrombolysis. Repeat angiogram performed showed left first rib completely occluding left subclavian vein when left UE adbucted to 90 degrees, good flow when left UE in neutral position. He was discharged home on Xarelto. Patient underwent hypercoagulability studies during admission and this was negative. Patient reports continued left arm numbness and tingling with abduction of the left arm. No edema or hand discoloration noted. Most recent duplex shows patent subclavian vein.