Paget-Schroetter syndrome/Paget-Schroetter sendromu

A 23-year-old male was admitted with right arm swelling and prominent superficial visible veins over the right side of the chest which was possibly associated to arm stretching exercise. His past medical history was unremarkable. Sonographic examination revealed thrombotic stenosis of the right subclavian vein. Venous angiogram of the right upper extremity disclosed non-visualization a part of the subclavian vein. Effort axillo-subclavian vein thrombosis occurring in otherwise normal individuals has been termed the Paget-Schroetter syndrome. This is an uncommon deep venous thrombosis due to repetitive activity of the upper limbs. Most cases of this condition are related to strenuous or prolonged sport or occupational activities, while others are associated with endogenous or exogenous risk factors. The most common cause is over stretching and contusion of the subclavian vein between the clavicle and first rib, during an unusual exercise of the arm. The damaged endothelium during this process initiates the thrombus formation, ultimately leading to obliteration of the subclavian vein. (Fig. 1, 2).

Untreated symptomatic patients can sustain long-term disability from venous obstruction resulting in significant loss of occupational productivity and quality of life. A majority of the literature supports a multimodal approach, but there is no definite consensus on management. Non-surgical intervention includes transcatheter thrombolytic therapy, at least 6 months of anticoagulation, limb elevation, graduated compression arm sleeve and balloon angioplasty. Thrombolytic therapy may restore the circulation if given within two or three days. Mechanical intervention with Angiojet can evacuate a large quantity of thrombus and thereby limit the dose and duration of thrombolytic therapy. Anticoagulation therapy has been suggested to be an adequate strategy in most patients. For surgical intervention resection of the first rib is one of the most common option. We treated him with low molecular weight heparin, followed by oral anticoagulant therapy for 6 months. Only partial resolution of thrombosis was achieved after 6 months of anticoagulant therapy. However, one year later axiller-subclavian venography demonstrated the veins to be nearly fully patent (Fig. 3). This case illustrates that, although unusual, Paget-Schroetter syndrome can occur in a healthy patient especially as a result of mild to moderate exercise.

References

References

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