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Clin Res Cardiol 96:4244 (2007)
DOI 10.1007/s00392-006-0450-3 CLINICAL CORRESPONDENCE
Subclavian vein thrombosis and backpacking
N. SchnC. NetzschK. Krger
Sirs: Thrombosis of the upper limb veins is rare (approximately 11%) compared to that of the lower limb veins [10]. One specific mechanism associated with subclavian vein thromboses is thoracic outlet syndrome (TOS). TOS represents a spectrum of disorders encompassing four related syndromes: arterial compression, venous compression, neurogenic compression and a poorly defined pain syndrome. Patients can present with signs of arterial insufficiency, venous obstruction, painless wasting of intrinsic
hand muscles and pain. History and physical examination are the most important diagnostic studies[9]. The diagnosis of a venous or arterial TOS requires a reproducible documentation of the compression of the vascular structure.
Of the patients, 96% have the neurological type of TOS, common from adolescence to age 50, but more common in females. 3% have the venous type, common in young males because they are more susceptible to muscular strain and hypertrophy.
1% have the arterial type, common in young adults with mostly cervical rib and in older patients with tissue involution and degeneration, e.g., drooping of the shoulders. Underlying congenital anomalies make patients anatomically susceptible to TOS. Cervical rib, the elongated transverse process of C7, abnormal fibromuscular bands around the scalenus, abnormal insertion of the muscles onto the first rib but also trauma to the lower neck structures and venous compression increases on effort and muscular action (effort-vein thrombosis, e.g., Paget Schroetter syndrome) are the reasons.
Primary, upper extremity, deep vein thrombosis (UEDVT) is classified as either idiopathic or as effort-related. The latter is also called Paget-Schroetter syndrome and is often referred to as spontaneous due to its unexpected presentation in healthy, generally young individuals (early 30 s, 2:1 predilection of males to females), with 75% of patients reporting an antecedent event of strenuous or repetitive activity before presentation. The dominant extremity is involved in 6080% of cases [10]. The cause is multi-farious but mostly involves extrinsic compression of the subclavian vein at the thoracic inlet or in the costaclavicular space. Abduction of the upper limbs, cervical extension and drooping of the shoulders promotes narrowing of this space. Repetitive micro-tauma to the vessel wall results in fibrous tissue formation that permanently strangles the vein, predis-
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