Venous Thoracic Outlet Syndrome

Venous Thoracic Outlet Syndrome
Jun 27, 2019 8:22pm

I (Geo) recently learned of an acquaintance who has developed venous thoracic outlet syndrome (VTOS), also termed "effort thrombosis" or more formally, Paget-Schroetter syndrome. This is thrombosis of the axilosubclavian vein where the vein passes by the junction of the clavicle and first rib. VTOS is rare, and is seen in athletes, for example, baseball pitchers, probably due to strain on the thoracic outlet region. Treatment includes catheter-directed thrombolysis. I've attached a concise review article that describes the etiology, symptoms, treatment, and prognosis of VTOS. Please click on the reference below to learn about this fascinating disorder.

Illig KA, Doyle AJ. A comprehensive review of Paget-Schroetter syndrome. J Vasc Surg 2010;51: 1538–47.

2 Comments

I (Geo) recently learned of an acquaintance who has developed venous thoracic outlet syndrome (VTOS), also termed "effort thrombosis" or more formally, Paget-Schroetter syndrome. This is thrombosis of the axilosubclavian vein where the vein passes by the junction of the clavicle and first rib. VTOS is rare, and is seen in athletes, for example, baseball pitchers, probably due to strain on the thoracic outlet region. Treatment includes catheter-directed thrombolysis. I've attached a concise review article that describes the etiology, symptoms, treatment, and prognosis of VTOS. Please click on the reference below to learn about this fascinating disorder.

Illig KA, Doyle AJ. A comprehensive review of Paget-Schroetter syndrome. J Vasc Surg 2010;51: 1538–47.

By George Fritsma
Jun 29, 2019 3:09pm
My friend subsequently remarked that his surgeon has seen an increase in VTOS diagnoses recently and attributes it to an increase in upper body exercise regimens offered in health clubs. He is currently on Lovenox and is likely to be switched to a DOAC this week. He will also be evaluated for surgery, which usually means resection of the first rib.
By Dr. Vadim Kostousov
Jul 23, 2019 12:03pm
Some other quite unusual physical activities (besides weight-lifting) that can lead to effort-related upper extremity DVT, published in last 5 years:

Weaver LA, et al. Effort thrombosis provoked by saxophone performance. J Emerg Med. 2019;56:323–6.
Chu AS, et al. Spontaneous subclavian vein thrombosis in a healthy adolescent cheerleader: a case of Paget-Schroetter syndrome. Pediatr Emerg Care. 2017;33:e92–4.
Stake S, et al. Upper extremity deep vein thromboses: the bowler and the barista. Case Rep Vasc Med. 2016;2016:9631432.
Keen DJ. Upper extremity deep vein thrombosis (Paget-Schroetter syndrome) after surfing: a case report. Man Ther. 2015;20:358–60.

All previously published reports with particular causes of UDVT are reviewed in table 1 on the link below:

Young K, et al. Subclavian vein thrombosis in an otherwise healthy 9-year-old boy. BMJ Case Rep. May 22, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4039887/

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