Effort Thrombosis of the Subclavian Vein

ABSTRACT

Spontaneous thrombosis of the subclavian vein, termed "effort thrombosis" or the Paget-Schroetter Syndrome, has long been considered a primary thrombotic process, but recent experience suggests that it may commonly result from repeated mechanical compression. This syndrome is unusual and is frequently considered inconsequential compared with thrombosis of the iliac or femoral vein. However, pulmonary embolism has been documented in up to 15% of patients with subclavian thrombosis. Many patients with this disorder are offlicted by disabling symptoms of upper extremity venous congestion. It is now recognized that the morbidity of this condition is significant and its traditional treatment needs serious reconsideration. Presumed to be a primary thrombotic disorder, its treatment has traditionally consisted of arm elevation and anticoagulation. Increased awareness of the pathophysiology of this symdrome can allow timely, improved diagnostic screening and use of specific surgical intervention to relieve the venous consequences. During the 44 months we have treated 5 patients with the thrombosis of subclavian vein. There were two men and three women with an average of 50 years(range from 40~61 years). And all patients presented with pain, swelling, and cyanosis of the upper extremity. Venous congestion worsened especially with abduction of the arm. Three of five patients were originally treated with arm elevation and anticoagulation; two also underwent surgical intervention.