Effort thrombosis (Paget-Schroetter syndrome) in active young adults: Current concepts in diagnosis and treatment

Shebel, Nancy D.; Marin, Alice

doi:10.1016/j.jvn.2006.09.003

Cited by 36 publications

(32 citation statements)

References 27 publications

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“…A prominent venous pattern consisting of dilated superficial collateral veins over the upper arm, base of the neck, and anterior chest wall develops in many patients, especially if occlusion is chronic. 5,8,10,12,25,26 The diagnosis is usually straightforward. A duplex ultrasound scan is diagnostic, with high accuracy in experienced hands.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Essentially, no prospective randomized trials concerning the treatment of effort thrombosis exist; most of what we do today is guided by single series reports, retrospective reviews, expert opinion, book chapter, and general review articles (for example, Swinton et al 4 [1968] for an early overview, Shebel and Marin 5 [2006] for a very readable review presented to vascular nurses, and Landry and Liem 6 [2007] for a recent endovascular update). At this point in time, we feel that certain areas are well-established by consensus, but point out that prospective randomized trials are sorely needed.…”

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confidence: 99%

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A comprehensive review of Paget-Schroetter syndrome

Illig

Doyle

2010

Journal of Vascular Surgery

350

320

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Venous thoracic outlet syndrome progressing to the point of axilosubclavian vein thrombosis, variously referred to as Paget-Schroetter syndrome or effort thrombosis, is a classic example of an entity which if treated correctly has minimal long-term sequelae but if ignored is associated with significant long-term morbidity. The subclavian vein is highly vulnerable to injury as it passes by the junction of the first rib and clavicle in the anterior-most part of the thoracic outlet. In addition to extrinsic compression, repetitive forces in this area frequently lead to fixed intrinsic damage and extrinsic scar tissue formation. Once primary thrombosis is recognized, catheter-directed thrombolytic therapy is usually successful if initiated within ten to 14 days of clot formation, but often unmasks an underlying lesion. The vast majority of investigators believe that decompression of the venous thoracic outlet, usually by means of first rib excision, partial anterior scalenectomy, resection of the costoclavicular ligament, and thorough external venolysis, is necessary, although opinion is less uniform as to the need for and method of treatment of the venous lesion itself. Using this algorithm, long-term success rates of 95 to 100% have been reported by many investigators. This review, in addition to discussing the overall treatment algorithm in more detail, attempts to point out controversies that still exist and research directions, both clinical and basic, that need to be pursued. Prospective randomized trials addressing this entity are surprisingly lacking, and although there is consensus based on experience, it may be necessary to step back and rigorously explore several aspects of this entity.

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Section: Clinical Presentationmentioning

confidence: 99%

mentioning

confidence: 99%

A comprehensive review of Paget-Schroetter syndrome

Illig

Doyle

2010

Journal of Vascular Surgery

350

320

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“…Causes of UEDVT are various and are commonly related to immobility following surgery or casting, central venous catheterization, and strenuous muscular activity [2]. More remote but important cause includes thoracic outlet syndrome (TOS), in which nervous and vascular bundles are compressed at the base of the neck between the first or cervical rib and the clavicle [3].…”

Section: Case Discussionmentioning

confidence: 99%

Bilateral Upper Extremity DVT in a 43-Year-Old Man: Is It Thoracic Outlet Syndrome?!

Jabri

Mukherjee

Sanghavi

et al. 2014

Case Reports in Medicine

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Recurrent deep venous thrombosis, involving bilateral upper extremities, is an extremely rare phenomenon. We are presenting a 43-year-old man who was diagnosed with left upper extremity deep vein thrombosis (UEDVT) and was treated with anticoagulation and surgical decompression in 2004. 9 years later, he presented with right arm swelling and was diagnosed with right UEDVT using US venous Doppler. Venogram showed compression of the subclavian vein by the first rib, diagnosing thoracic outlet syndrome (TOS). He was treated with anticoagulation and local venolysis and later by surgical decompression of the subclavian vein. Bilateral UEDVT, as mentioned above, is an extremely rare condition that is uncommonly caused by TOS. To our knowledge, we are reporting the first case of bilateral UEDVT due to TOS. Diagnosis usually starts with US venous Doppler to detect the thrombosis, followed by the gold standard venogram to locate the area of obstruction and lyse the thrombus if needed. The ultimate treatment for TOS remains surgical decompression of the vascular bundle at the thoracic outlet.

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“…If the vein continues to experience external compression, symptoms may reoccur. 41,43,46 A venogram is performed after thrombolysis to determine whether residual extrinsic compression occurs in either the anatomic position or during shoulder abduction. 41,43,45 Because of the risk of reoccurrence of thrombosis and symptoms, many authors recommend surgical decompression via removal of the first rib, even when the vein is completely opened with thrombolytic treatment.…”

Section: Arterial Tosmentioning

confidence: 99%

Thoracic outlet syndrome: a controversial clinical condition. Part 2: non-surgical and surgical management

Hooper¹,

Denton²,

McGalliard³

et al. 2010

Journal of Manual & Manipulative Therapy

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Background: Proper management of thoracic outlet syndrome (TOS) requires an understanding of the underlying causes of the disorder. A comprehensive examination process, as described in Part 1 of this review, can reveal the bony and soft tissue abnormalities and mechanical dysfunctions contributing to an individual's TOS symptoms. Objective: Part 2 of this review focuses on management of TOS. Conclusion: The clinician uses clinical examination results to design a rehabilitation program that focuses on correcting specific problems that were previously identified. Disputed neurogenic TOS is best managed with a trial of conservative therapy before surgical treatment options are considered. Cases that are resistant to conservative treatment may require surgical intervention. True neurogenic TOS may require surgical intervention to relieve compression of the neural structures in the thoracic outlet. Surgical management is required for cases of vascular TOS because of the potentially serious complications that may arise from venous or arterial compromise. Post-operative rehabilitation is recommended after surgical decompression to address factors that could lead to a reoccurrence of the patient's symptoms.

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Effort thrombosis (Paget-Schroetter syndrome) in active young adults: Current concepts in diagnosis and treatment

Cited by 36 publications

References 27 publications

A comprehensive review of Paget-Schroetter syndrome

A comprehensive review of Paget-Schroetter syndrome

Bilateral Upper Extremity DVT in a 43-Year-Old Man: Is It Thoracic Outlet Syndrome?!

Thoracic outlet syndrome: a controversial clinical condition. Part 2: non-surgical and surgical management

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