Arm vein thrombosis paget-von-schroetterI80.81
Synonym(s)
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
HistoryThis section has been translated automatically.
Cruveilhier, 1816; Paget, 1875; v. Schroetter, 1884
DefinitionThis section has been translated automatically.
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.
Occurrence/EpidemiologyThis section has been translated automatically.
About 1-2% of all venous thromboses of the extremities.
EtiopathogenesisThis section has been translated automatically.
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.
ManifestationThis section has been translated automatically.
Mainly men of working age. Ratio of men to women: 3:1.
LocalizationThis section has been translated automatically.
Right arm in 2/3 of the cases.
Clinical featuresThis section has been translated automatically.
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.
DiagnosisThis section has been translated automatically.
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 diagnosisThis section has been translated automatically.
Vena-cava-superior syndrome, superficial thrombophlebitis, shoulder-hand syndrome, axillary lymph node metastases, scalenus syndrome.
Complication(s)This section has been translated automatically.
Rarely pulmonary embolism (about 10%).
TherapyThis section has been translated automatically.
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.
Progression/forecastThis section has been translated automatically.
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.
LiteratureThis section has been translated automatically.
- Cruveilhier LJB (1816) Essai sur l'anatomie pathologique en général et sur les transformations et productions organiques en particulier. Doctoral thesis, 2 vol., Paris
- Hesse G, Stiegler H (2003) Ultrasound diagnostic techniques in dermatologic angiology and phlebology. dermatologist 54: 614-625
- Huber P et al (1987) Axillary subclavian thrombosis and its consequences. Internist 28: 336-343
- Lechner W (1981) Postthrombotic axillary vein syndrome. Dermatologist 32: 313-316
- Nannapaneni R et al (2003) Neurogenic thoracic outlet syndrome. Br J Neurosurg 17: 144-148
- Paget J (1866) On gouty and some other forms of phlebitis. St. Bartholomew's Hosp Reports (London) 2: 82-92
- Paget J (1875) Clinical lectures and essays. Langman & Green, London, S. 292
- Tilki HE et al (2004) Bilateral neurogenic thoracic outlet syndrome. Muscle nerve 29: 147-150
- v. Schroetter L (1884) Vascular diseases. In: Nothnagels Handbuch der Pathologie und Therapie. Hölder, Vienna