Effort Subclavian Vein Thrombosis

What is Effort Subclavian Vein Thrombosis?

Effort subclavian vein thrombosis — also known as Paget-Schrotter syndrome — is a blood clot that occurs in the vein under the collarbone known as the subclavian vein. It usually occurs when the vein is compressed between the first rib and collarbone and is a special type of thoracic outlet syndrome. The blood clot that forms in the subclavian vein causes blood to back up in the veins in the arm, causing the veins to swell and the arm to swell and ache.

Causes

• Presence of an extra rib above the first rib that compresses the subclavian vein
• Previous fracture of the collarbone or first rib
• An abnormal ligament that compresses the subclavian vein
• Repetitive movement of the arm and shoulder with the arm extended over the head (often occurs with swimmers, tennis players, baseball pitchers, basketball players and people in certain jobs)

Risk Factors

• Large neck and upper-arm muscles or overexertion of those muscles

What are the Symptoms?

• Pain, swelling or congestion in the affected arm
• Affected arm turns blue

How is Effort Subclavian Vein Thrombosis Diagnosed?

• Ultrasound Imaging: Sound waves are used to create an image of the veins and identify the presence of blood clots.
• Venogram: This procedure injects a dye into a vein to make blood flow visible on an X-ray, which measures blood flow in the veins and looks for signs of clots.
• Magnetic Resonance Venous (MRV) imaging: Radio waves and strong magnetic fields are used to image the subclavian vein to detect compression or blood clots in the vein.

Treatment at UVA's Heart and Vascular Center

• Anticlotting (anticoagulant) medications: The doctor may recommend taking anticoagulant medicines that prevent further blood clots from forming.
• Thrombolysis: Once a clot is identified, the clot needs to be dissolved to prevent long-term problems. A catheter is inserted into a vein in the arm and moved to the clot's location under the collarbone. Medication is then applied to the clot to break it up slowly or dissolve it. Following the procedure, the patient will need to take anticoagulant medication to keep new clots from forming.
• Surgery: Once the clot is dissolved, surgery will likely be required to remove the segment of rib and the ligaments and muscles that caused compression of the vein, leading to the formation of the blood clot.