Semin intervent Radiol 2012; 29(01): 044-051
DOI: 10.1055/s-0032-1302451
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comprehensive Management of Subclavian Vein Effort Thrombosis

Robert W. Thompson
1   The Center for Thoracic Outlet Syndrome and the Department of Surgery, Section of Vascular Surgery
2   Radiology, Washington University School of Medicine, St. Louis, Missouri
› Author Affiliations
Further Information

Publication History

Publication Date:
16 April 2012 (online)

Zoom Image

Abstract

Subclavian vein (SCV) effort thrombosis, also known as the Paget-Schroetter syndrome, is a relatively uncommon condition that affects young, active, otherwise healthy individuals. It is considered a form of thoracic outlet syndrome, arising as a consequence of compression and repetitive injury of the SCV between the first rib and the overlying clavicle, as well as the anterior scalene muscle, subclavius muscle, and costoclavicular ligament. Effort thrombosis is distinct from other forms of deep vein thrombosis with respect to pathophysiology, clinical presentation, and functional consequences, and it requires treatment considerations unique to effective management of thoracic outlet compression as well as the obstructed SCV. In this review the comprehensive management of SCV effort thrombosis is addressed, with an emphasis on current interventional radiology techniques used in conjunction with definitive surgical treatment, based on early catheter-based venography, thrombolytic therapy, and prompt paraclavicular thoracic outlet decompression with direct SCV reconstruction.