ABSTRACT
RATIONALE: Thoracic outlet syndrome (TOS) is a rare cause of upper extremity deep vein thrombosis (UEDVT). The treatment usually involves catheter directed thrombolysis followed by systemic anticoagulation. Surgical decompression is frequently recommended after anticoagulation for definitive therapy. PATIENT CONCERNS: We report two cases of UEDVT secondary to venous TOS with important clinical presentations. DIAGNOSES: Venous TOS. INTERVENTIONS: One patient was initially treated conservatively but had a recurrent UEDVT. The second patient had a residual stump from a prior rib resection that was causing compression on the subclavian vein, resulting in recurrent venous symptoms. OUTCOMES: Both patients achieved significant improvement in their symptoms at 1 year follow-up. LESSONS: UEDVTs can be debilitating, and may limit activities of daily living. Surgical decompression may offer significant improvement in quality of life and symptom relief in such patients.
Subject(s)
Anticoagulants/administration & dosage , Decompression, Surgical/methods , Quality of Life , Thoracic Outlet Syndrome/complications , Thrombolytic Therapy/methods , Upper Extremity Deep Vein Thrombosis , Activities of Daily Living , Adult , Female , Humans , Middle Aged , Secondary Prevention/methods , Thoracic Outlet Syndrome/diagnosis , Thoracic Outlet Syndrome/physiopathology , Thoracic Outlet Syndrome/therapy , Treatment Outcome , Upper Extremity Deep Vein Thrombosis/diagnosis , Upper Extremity Deep Vein Thrombosis/etiology , Upper Extremity Deep Vein Thrombosis/psychology , Upper Extremity Deep Vein Thrombosis/therapyABSTRACT
BACKGROUND: To determine the impact of the postthrombotic syndrome (PTS) on quality of life after primary upper extremity deep venous thrombosis (UEDVT). PATIENTS AND METHODS: Twenty-five patients with a history of primary UEDVT, treated with anticoagulation alone, and twenty healthy controls were retrospectively identified and prospectively assessed for health-related quality of life (SF-36 and VEINES-QOL-questionnaire) and upper extremity functional impairment (DASH-score). Presence of PTS was classified according to the modified Villalta-score. Comparisons between patients and controls and between patients with and without PTS were performed using Fisher`s exact test (categorical variables) and Mann-Whitney-U-test (continuous variables). RESULTS: According to the modified Villalta-score, 32 % of the patients suffered from mild to moderate PTS. None of the patients developed severe PTS. Compared to healthy control subjects, patients with a history of primary UEDVT reported on considerably worse health-related quality of life and significantly stronger upper extremity functional impairment. Within the cohort of patients with UEDVT, subjects with PTS had a significantly reduced quality of life and a more severe functional limitation. CONCLUSIONS: Quality of life and functional performance are impaired in patients with a history of conservatively treated primary UEDVT. Impairment is most pronounced in patients with mild to moderate PTS occurring in every third patient.
