Arm vein thrombosis paget-von-schroetter I80.81

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Arm vein congestion; axillary vein congestion acute; Axillary Vein Syndrome; Axillary Vein Thrombosis; Axillary venous thrombosis; effort thrombosis; Effort thrombosis; intermittent venous claudication (Löhr); Paget-von-Schroetter syndrome; Shoulder girdle venous thrombosis; syndrome neurovasculaire du membre supérieur; Thrombosis par effort; Venous Effort Syndrome

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Cruveilhier, 1816; Paget, 1875; v. Schroetter, 1884

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Acute thrombotic occlusion of the subclavian or axillary veins due to microtrauma or intimate tears in the vein, including venous congestion, prominence of the humeral veins and infraclavicular or axillary pressure pain.

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About 1-2% of all venous thromboses of the extremities.

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Various causes have been described: working with strong movements in the shoulder girdle area (wood chopping, stretching), extreme over-extension of the arm, poor posture during sleep, cervical rib, osteomas of the anterior scalenal gap, substernal goiter, Pancoast tumor, lesion of the vein by application of central venous catheters or pacemaker probes. Tumor compression of the vein (e.g. bronchus-Ca), obstruction of the V. cava superior, disturbance of the venous flow in right heart failure, hemostasis disturbances in thrombophilia, polyglobulia, anemia, tumors. Polycythaemia, see also intermittent claudication. Medication: application of hypertonic solutions, concentrated antibiotics, cytostatics, drugs, contraceptives, ovulation inhibitors.

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Mainly men of working age. Ratio of men to women: 3:1.

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Right arm in 2/3 of the cases.

Clinical features
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Unilateral swelling of the arm with emphasis on the hand and forearm, bulging vein filling, cyanosis, paraesthesias, painful palpable strand in the sulcus bicipitalis, sudden swelling of the arm with cyanosis and a feeling of tension up to the shoulder region, pain level usually low. With subacute closure (e.g. tumour compression, catheter lesion) often only moderate tendency to swelling. Supra-, infraclavicular and axillary pressure pain, rarely acroparaesthesia. Prominence of the humeral veins, formation of venous collaterals over the shoulder and pectoralis region.

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Doppler-sonographic detection of the closure. Phlebographically complete stop or thrombus flow around the axillary or subclavian veins. In subacute and chronic stages a strong collateral system can be visualized.

Differential diagnosis
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Vena-cava-superior syndrome, superficial thrombophlebitis, shoulder-hand syndrome, axillary lymph node metastases, scalenus syndrome.

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Rarely pulmonary embolism (about 10%).

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Fibrinolytics (streptokinase, urokinase, rt-PA, TNK-t-PA) systemic max. for 5 days or local catheter lysis is the first choice. Operative therapy in case of failure of conservative therapy, persistent cause of compression or recurrent thrombosis (rare). Cooperation with the vascular surgeon. Procedure: Trendelenburg positioning, visualization of the axillary vein, thrombectomy with Fogarty catheter. Postoperative: Heparin-Marcumar therapy for 6 months. In case of development of a postthrombotic syndrome: compression therapy, nocturnal elevation of the arm.

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Usually favorable: Collateralization via the cephalic vein, neck and chest wall veins. Rare development of postthrombotic syndrome in the arm. Very rarely transition to phlegmasia coerulea dolens.

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Last updated on: 29.10.2020