Subclavian Effort and Upper Limb Thrombosis – a Lesson Learned

Abstract

Subclavian vein effort and upper limb thrombosis, known as the Paget-Schroetter syndrome (PSS), accounts for 30–40 % of spontaneous upper extremity deep vein thromboses (UEDVTs) and 10–20 % of all upper limb deep vein thromboses (DVTs). As complication of PSS include post-thrombotic syndrome and pulmonary embolism, early recognition and prompt initiation of anticoagulant treatment is crucial in the course of its treatment. PSS is associated with single or repeated physical activity of the upper limb, combined with obstruction of venous outflow resulting from anatomical alterations. A correct diagnosis, based on a range of imaging methods, and prompt initiation of local thrombolytic therapy, surgical decompression of the thoracic outlet (when necessary), and immediate initiation of anticoagulant treatment, aim to effectively restore the patient life quality, preventing post-thrombotic syndrome and recurrent thrombosis.

Zusammenfassung

Die Effort-Thrombose der Vena subclavia und die Thrombose der oberen Gliedmaßen werden als Paget-Schroetter-Syndrom (PSS) bezeichnet. Sie machen 30–40% der spontanen tiefen Venenthrombosen der oberen Extremitäten und 10–20% aller tiefen Venenthrombosen der oberen Extremitäten aus. Zu den Komplikationen des PSS werden das postthrombotische Syndrom und die Lungenembolie gezählt. Daher sind das frühzeitige Erkennen und die unverzügliche Einleitung einer gerinnungshemmenden Behandlung für den Verlauf von entscheidender Bedeutung. Das PSS tritt bei einmaliger oder wiederholter körperlicher Betätigung der oberen Gliedmaßen in Verbindung mit einer Obstruktion des venösen Abflusses infolge anatomischer Veränderungen auf. Eine korrekte Diagnose auf der Grundlage verschiedener bildgebender Verfahren und die unverzügliche Einleitung einer lokalen Thrombolysetherapie – einer chirurgischen Dekompression des Thoraxauslasses (falls erforderlich) und die sofortige Einleitung einer gerinnungshemmenden Behandlung – sollen die Lebensqualität des Patienten wirksam wiederherstellen und ein postthrombotisches Syndrom sowie eine erneute Thrombose verhindern.

Schlüsselwörter

Tiefe Venenthrombose der oberen Extremitäten - Thoracic-Outlet-Syndrom - Thrombose der Vena subclavia - Paget-Schroetter-Syndrom - Thrombolyse - Resektion der ersten Rippe

Keywords

upper extremity deep vein thrombosis - thoracic outlet syndrome - subclavian vein thrombosis - Paget-Schroetter syndrome - thrombolysis - first rib resection

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