Primary Subclavian-Axillary Vein Thrombosis

Swinton, Neil W.; Edgett, Joseph W.; Hall, Robert J.

doi:10.1161/01.cir.38.4.737

Cited by 141 publications

(43 citation statements)

References 34 publications

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“…This syndrome was first related to forced muscular abduction leading to vein compression and microtrauma of vessel intimae by the subclavius muscle or the costocoracoid ligament. In the 1970s, additional cases of UEDVT were reported that involved other contributing anatomic variations of the structures comprising the thoracic outlet, such as cervical rib, anomalous musculofascial bands, hypertrophied venous valves, or aberrant pectoralis tendons [17,18]. This entity was found to occur typically in healthy young men, within the active age group, mainly in the dominant arm.…”

Section: Discussionmentioning

confidence: 99%

Primary upper‐extremity deep vein thrombosis: High prevalence of thrombophilic defects

et al. 2004

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Primary deep venous thrombosis of the upper extremity (UEDVT) is an unusual disorder. Limited data are available on the contribution of hypercoagulable status in the pathogenesis of this disease. This study aims to report the prevalence of inherited and acquired thrombophilic risk factors (TF) in patients with primary (effort-related and spontaneous) UEDVT. From 1993 to 2002, 31 patients (17 females, median age 38.8 years, range 16-60 years; and 14 males, median age 31.4 years, range 20-56 years) with primary UEDVT (n = 15 effort-related and n = 16 spontaneous) were referred for screening of hypercoagulable status. Nineteen (61.3%) patients had at least one coagulation abnormality. The most common acquired TF were antiphospholipid antibodies (31% lupus anticoagulant and 12.9% anticardiolipin antibodies). Factor V Leiden (12.9%) and prothrombin G20210A mutation (20%) were the most prevalent genetic risk factors. Five patients (16.1%) had high plasma homocysteine levels, and one patient (4.7%) had protein S deficiency. Effortrelated UEDVT was associated with male gender (P = 0.04) and younger age (P = 0.02). There was no significant difference in the prevalence of acquired or inherited TF between patients with effort-related or spontaneous UEDVT. A local anatomic abnormality was detected in seven patients (22.5%), and the prevalence of TF was significantly lower within this group (P = 0.006). The incidence of TF in patients without an anatomic abnormality was 75% (RR 5.25). This study found a high prevalence of an underlying thrombophilic status in spontaneous and effort-related UEDVT. Hypercoagulable status may play a significant role in both groups. Screening for local anatomical abnormalities and thrombophilia should be included in the evaluation of primary UEDVT. Am.

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Section: Discussionmentioning

confidence: 99%

Primary upper‐extremity deep vein thrombosis: High prevalence of thrombophilic defects

et al. 2004

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“…Anticoagulation has been shown to prevent clot propagation, to facilitate the maintenance of venous collaterals [31] and to prevent pulmonary embolism [32]. There is also evidence that anticoagulation is effective in preventing long-term sequelae of chronic venous insufficiency [33].…”

Section: Investigation Of Uldvtmentioning

confidence: 99%

Upper Limb Deep Vein Thrombosis: A Literature Review to Streamline the Protocol for Management

et al. 2007

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Objective: The objective of this article is to provide up-to-date information about aetiology, pathogenesis, diagnostic modalities and treatment of upper limb deep vein thrombosis (ULDVT). Methods: Generic terms including ULDVT, axillary-subclavian DVT, and complications of central venous catheters were searched on electronic database. We analysed original studies, review articles and evaluation studies published over the last 25 years. Results: Forty-seven studies on ULDVT encompassing 2,557 patients were evaluated. The incidence of ULDVT was quoted 1–4% of the total DVT. Primary ULDVT (20% of the total) was due to activity-related venous trauma. Secondary ULDVT (80% of the total) was due to central venous catheters and malignancy. Duplex ultrasound (sensitivity 78–100% and specificity 82–100%), contrast venography (gold standard) and magnetic resonance venography were the diagnostic tools used. Pulmonary embolism (2–35%) and post-thrombotic syndrome (7–46%) were the main sequelae. Anticoagulation was the universal intervention, giving 79% symptom relief (13.2% rethrombosis rate). Thrombolysis and/or percutaneous thrombectomy were used in 38% of cases for the management of ULDVT, giving 83% symptom relief (90% recanalization rate and 9% rethrombosis rate). Surgical decompression, venous angioplasty and superior vena cava filters were the main adjunctive interventions. Conclusion: ULDVT, although rare, is associated with considerable morbidity and mortality (29–40%) due to potential risks of pulmonary embolism, post-thrombotic syndrome and loss of vascular access. Simple anticoagulation is suitable for the majority of patients. Thrombolysis/thrombectomy is often successful but less frequently used. Surgical decompression, venous angioplasty and superior vena cava filters have some role in recurrent cases. An optimal management protocol can be established using a multimodality approach.

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“…3 In those cases where no obvious etiology is forthcoming, the thrombosis is thought to be preceded by an ill-defined mechanism of trauma brought on by ''effort,'' and this condition is called Paget-Schroetter syndrome. 6,11 Despite the absence of an obvious etiology, anatomic anomalies such as cervical ribs, muscular fascial bands, and hypertrophied muscles (subclavius muscle and anterior scalene muscles) have been implicated in the pathogenesis of primary DVT of the upper extremity. 7,8 The onset of symptoms can be quite variable and has been described as being between 2 days and 3 years in one series.…”

Section: Discussionmentioning

confidence: 99%