• Repetitive arm activity and exercise
• Significant superficial venous distention in arm/shoulder
• Aching pain
• Cyanosis of chest wall, axilla, shoulder, and arm
• Other symptoms of thoracic outlet syndrome may be present (see Thoracic Outlet Syndrome)
Subclavian Venous Thrombosis
• Duplex US of upper extremity
• Venography + thrombolysis considered if duplex US is abnormal (positional venography with arm abducted 120 degrees)
• Chest film: Exclude cervical rib
• Duplex US
• Possible venogram
• Remove indwelling central lines/ pacemakers
• Elevate arm, hydrate with IV fluid
• Vein compression with large collaterals suggests venous thoracic outlet syndrome and necessitates early operation
• Surgical thoracic outlet decompression
• Excellent if treated early
• If thrombosis exists > 3 mos, it does not respond to therapy and may cause significant long-term disability
• Virchow's triad: Stasis, vascular injury, hypercoagulability
–Stasis: Venous insufficiency, heart failure, prolonged bed rest/plane travel
–Endothelial injury: Direct trauma, chemotherapy infusion, previous DVT, phlebitis, operative trauma all increase release of tissue factor increasing thrombin and decreasing fibrinolysis
–Hypercoagulability: Malignancy, protein C or S deficiency, disseminated intravascular coagulation (DIC), liver failure, elevated homocysteine, factor V Leiden, prothrombin gene variant, paroxysmal nocturnal hemoglobinuria
• Important risk factors
• Other risks
• Most common in calf ...
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