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Review
. 2022 Aug 31;39(3):304-311.
doi: 10.1055/s-0042-1753481. eCollection 2022 Jun.

Subclavian Effort Thrombosis: Pathophysiology, Diagnosis, and Management

Eric C King  1 , Roger E Goldman  1 , Matthew Schwenke  1 , Amir A Sarkeshik  2
Affiliations
Review

Subclavian Effort Thrombosis: Pathophysiology, Diagnosis, and Management

Eric C King et al. Semin Intervent Radiol. .

Erratum in

Abstract

Subclavian vein (SCV) effort thrombosis, also known as Paget-Schroetter syndrome or venous thoracic outlet syndrome, is an uncommon condition that affects individuals with an irregularly narrow thoracic outlet who engage in repetitive overhead motions of the affected arm. Venous injury arises from microtraumas that occur from the repetitive compression of the SCV between the first rib and the overlying clavicle. Additional sources of extrinsic compression can be due to the anterior scalene muscle, subclavius muscle, and costoclavicular ligament. SCV effort thrombosis is a distinct entity from other forms of deep venous thrombosis and requires unique diagnostic and treatment considerations. Early catheter-directed therapy in the form of pharmacomechanical or catheter-directed thrombolysis combined with prompt surgical thoracic outlet decompression offers patients the best chances for early and durable symptom relief.

Keywords: Paget-Schroetter; angioplasty; chest; effort thrombosis; interventional radiology; thoracic outlet syndrome; thrombolysis; venous thrombosis.

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Conflict of interest statement

Conflict of Interest None declared.

Figures

Fig. 1
Fig. 1
Neurovascular bundle in the scalene triangle.
Fig. 2
Fig. 2
Superficial venous collaterals on physical exam suggest central venous stenosis or occlusion.
Fig. 3
Fig. 3
Coronal magnetic resonance venography with the patient's arms abducted. A filling defect (arrow) is visible in the left axillary and subclavian veins.
Fig. 4
Fig. 4
Coronal magnetic resonance venography with the patient's arms at the side ( a ) and abducted ( b ) showing physiologic compression of the subclavian vein with abduction (circles). No collateral veins are seen.
Fig. 5
Fig. 5
Coronal digital subtraction venogram demonstrating left subclavian vein occlusion with collateral veins ( a , arrow) which was subsequently treated with angioplasty with persistent waist of the balloon ( b , arrow). After angioplasty, the left subclavian vein remains small in caliber with filling defects consistent with vascular webs and persistent venous collaterals ( c ). The patient went on to surgical decompression.
Fig. 6
Fig. 6
Transaxillary surgical exposure.
See this image and copyright information in PMC

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