In the subclavian vein, a main vein that drains blood from the upper limb toward the heart, a blood clot (thrombus) form.
The artery is located both superiorly and posteriorly to the subclavian vein, which runs over the first rib and behind the clavicle.
Subclavian vein thrombosis was initially reported by Sir James Paget in 1875. He named the spontaneous thrombosis of the veins draining the upper extremities “gouty phlebitis.”
Paget observed that the injured extremity swelled and hurt, but he mistakenly thought that the phenomenon was caused by vasospasm.
This syndrome, according to von Schrötter’s 1884 theory, was caused by occlusive thrombosis of the axillary and subclavian veins.
Hughes created the term Paget-von Schrötter syndrome in 1949 to honor the efforts of these pioneers. Indwelling catheters can cause thrombosis of the subclavian vein, which is a similar disease.
Due to the widespread use of central venous catheters (CVCs) in patients with cancer, renal failure, and other chronic medical illnesses, the incidence of this disorder has significantly increased over the past 20 years.
Epidemiology
Axillary or subclavian vein thrombosis made about 1-2% of all deep vein thrombosis (DVT) cases prior to 1967.
Due to the increased use of central venous access for a variety of clinical problems the incidence has increased.
The dominant arm is where thrombosis occurs in 80% of patients with subclavian vein stenosis and effort-induced thrombosis.
Between 4% and 10% of all cases of deep vein thrombosis (DVT) are caused by UEDVT. The subclavian vein is one of the most impacted areas in UEDVT patients.
According to estimates, there are 1 to 2 cases of primary (effort-related) SVT per 100,000 persons each year mostly in young active people.
Anatomy
Pathophysiology
The internal jugular vein and femoral vein appear to have comparable thrombotic problems in hemodialysis patients.
Due to the extremely high risk of thrombosis, the subclavian vein should be avoided for both short-term and long-term hemodialysis.
This condition was dubbed “effort-induced thrombosis” in the 1960s to recognize that it occurs after exceptionally demanding usage of the afflicted side’s arm or shoulder.
It has been proposed that external compression of the axillary-subclavian vein plays a role in the blood stasis that causes thrombosis.
The subclavian vein’s venous flow is changed, and turbulence is increased when catheters and transvenous pacemakers are inserted.
It has documented that parenteral feeding and intravenous (IV) drugs can induce thrombophlebitis.
Etiology
Primary SVT
Secondary SVT
Repetitive Upper Limb Activity
Central Venous Catheters
Pacemaker or Implantable Cardioverter-Defibrillator (ICD) Leads
Malignancy
Hypercoagulable States
Genetics
Prognostic Factors
The case fatality rate for untreated ASVT-related PE can reach 10%, which is like the rate for lower extremity PE.
Venous occlusion has long-term effects that include significant morbidity associated with chronic discomfort and swelling.
Physical activity that involves prolonged use of the afflicted arm might aggravate these sensations.
There is growing proof that endovascular procedures are the preferred treatment option for patients with upper-extremity thrombosis because of advancements in this technology.
This method facilitates a far quicker recovery and, over time, results in lower morbidity and fewer problem
Clinical History
A history of trauma or, more commonly, excessive arm use (>50% of cases) may be mentioned by patients. Frequently occurring triggering actions include backward and downward rotation of the shoulder or repetitive hyperabduction and external rotation of the arm.
Most patients arrive to the emergency department (ED) within 24 hours due to the relatively significant symptoms of subclavian stenosis.
Similar symptoms linked with the indwelling catheter in the ipsilateral arm or shoulder are reported by patients with catheter-related axillary-subclavian vein thrombosis (ASVT).
Physical Examination
Palpation
Functional Tests
Systemic Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Acute symptoms are:
Swelling, pain or discomfort, Cyanosis or reddish discoloration of the arm, hand, or shoulder
Chronic symptoms are:
Sense of heaviness, tightness, or fatigue in the affected limb
Differential Diagnoses
Antiphospholipid Syndrome
Lymphedema
Pancoast Syndrome
Cellulitis
Superior Vena Cava Syndrome
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Thrombolytic treatment is advised for patients whose effort-induced vein thrombosis has lasted less than two weeks.
Warfarin is a conservative treatment for chronic axillary-subclavian vein thrombosis (ASVT), and surgical bypass is an option if symptoms are severe.
Conservative care is the first line of treatment for subclavian vein thrombosis. This includes rest, limb elevation, and the use of warm compresses or heat.
Physical therapy is the initial treatment for a small number of individuals with no anatomic abnormalities and few symptoms.
Weight loss and adhesion release at the blockage site are two benefits of structured physical therapy.
Treatment approaches for Paget-von Schrötter syndrome and catheter-induced subclavian vein thrombosis differ based on their distinct natural history.
Thrombolytic therapy is favoured over thrombectomy due to the absence of surgical risks and the potential for an intimal tear caused by the embolectomy catheter.
The elimination of urokinase from the US market compelled interventional radiologists to use tissue plasminogen activator (tPA) in less clinically defined regimens.
Patients with catheter-associated subclavian thrombosis frequently have substantial comorbidity, care must be taken when choosing which individuals should receive thrombolytic therapy.
Anatomic abnormalities include congenital fibromuscular bands, shortening of the costoclavicular space due to shoulder depression, or abnormal subclavius or scalenus anterior.
Endoluminal stent placement to avoid stent breakage due to compression against the first rib.
In acute phase management, the goal is to prevent thrombus extension and reduce symptoms.
In subacute phase management, the goal is to prevent recurrence and promote clot resolution.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional procedures.
The regular follow-up visits with the specialist are scheduled to check the improvement of patients along with treatment response.
In the subclavian vein, a main vein that drains blood from the upper limb toward the heart, a blood clot (thrombus) form.
The artery is located both superiorly and posteriorly to the subclavian vein, which runs over the first rib and behind the clavicle.
Subclavian vein thrombosis was initially reported by Sir James Paget in 1875. He named the spontaneous thrombosis of the veins draining the upper extremities “gouty phlebitis.”
Paget observed that the injured extremity swelled and hurt, but he mistakenly thought that the phenomenon was caused by vasospasm.
This syndrome, according to von Schrötter’s 1884 theory, was caused by occlusive thrombosis of the axillary and subclavian veins.
Hughes created the term Paget-von Schrötter syndrome in 1949 to honor the efforts of these pioneers. Indwelling catheters can cause thrombosis of the subclavian vein, which is a similar disease.
Due to the widespread use of central venous catheters (CVCs) in patients with cancer, renal failure, and other chronic medical illnesses, the incidence of this disorder has significantly increased over the past 20 years.
Axillary or subclavian vein thrombosis made about 1-2% of all deep vein thrombosis (DVT) cases prior to 1967.
Due to the increased use of central venous access for a variety of clinical problems the incidence has increased.
The dominant arm is where thrombosis occurs in 80% of patients with subclavian vein stenosis and effort-induced thrombosis.
Between 4% and 10% of all cases of deep vein thrombosis (DVT) are caused by UEDVT. The subclavian vein is one of the most impacted areas in UEDVT patients.
According to estimates, there are 1 to 2 cases of primary (effort-related) SVT per 100,000 persons each year mostly in young active people.
The internal jugular vein and femoral vein appear to have comparable thrombotic problems in hemodialysis patients.
Due to the extremely high risk of thrombosis, the subclavian vein should be avoided for both short-term and long-term hemodialysis.
This condition was dubbed “effort-induced thrombosis” in the 1960s to recognize that it occurs after exceptionally demanding usage of the afflicted side’s arm or shoulder.
It has been proposed that external compression of the axillary-subclavian vein plays a role in the blood stasis that causes thrombosis.
The subclavian vein’s venous flow is changed, and turbulence is increased when catheters and transvenous pacemakers are inserted.
It has documented that parenteral feeding and intravenous (IV) drugs can induce thrombophlebitis.
Primary SVT
Secondary SVT
Repetitive Upper Limb Activity
Central Venous Catheters
Pacemaker or Implantable Cardioverter-Defibrillator (ICD) Leads
Malignancy
Hypercoagulable States
The case fatality rate for untreated ASVT-related PE can reach 10%, which is like the rate for lower extremity PE.
Venous occlusion has long-term effects that include significant morbidity associated with chronic discomfort and swelling.
Physical activity that involves prolonged use of the afflicted arm might aggravate these sensations.
There is growing proof that endovascular procedures are the preferred treatment option for patients with upper-extremity thrombosis because of advancements in this technology.
This method facilitates a far quicker recovery and, over time, results in lower morbidity and fewer problem
A history of trauma or, more commonly, excessive arm use (>50% of cases) may be mentioned by patients. Frequently occurring triggering actions include backward and downward rotation of the shoulder or repetitive hyperabduction and external rotation of the arm.
Most patients arrive to the emergency department (ED) within 24 hours due to the relatively significant symptoms of subclavian stenosis.
Similar symptoms linked with the indwelling catheter in the ipsilateral arm or shoulder are reported by patients with catheter-related axillary-subclavian vein thrombosis (ASVT).
Palpation
Functional Tests
Systemic Examination
Acute symptoms are:
Swelling, pain or discomfort, Cyanosis or reddish discoloration of the arm, hand, or shoulder
Chronic symptoms are:
Sense of heaviness, tightness, or fatigue in the affected limb
Antiphospholipid Syndrome
Lymphedema
Pancoast Syndrome
Cellulitis
Superior Vena Cava Syndrome
Thrombolytic treatment is advised for patients whose effort-induced vein thrombosis has lasted less than two weeks.
Warfarin is a conservative treatment for chronic axillary-subclavian vein thrombosis (ASVT), and surgical bypass is an option if symptoms are severe.
Conservative care is the first line of treatment for subclavian vein thrombosis. This includes rest, limb elevation, and the use of warm compresses or heat.
Physical therapy is the initial treatment for a small number of individuals with no anatomic abnormalities and few symptoms.
Weight loss and adhesion release at the blockage site are two benefits of structured physical therapy.
Treatment approaches for Paget-von Schrötter syndrome and catheter-induced subclavian vein thrombosis differ based on their distinct natural history.
Thrombolytic therapy is favoured over thrombectomy due to the absence of surgical risks and the potential for an intimal tear caused by the embolectomy catheter.
The elimination of urokinase from the US market compelled interventional radiologists to use tissue plasminogen activator (tPA) in less clinically defined regimens.
Patients with catheter-associated subclavian thrombosis frequently have substantial comorbidity, care must be taken when choosing which individuals should receive thrombolytic therapy.
Surgery, Other
Adjust workstations or exercise regimens to reduce repeated or extended overhead activities.
The thoracic outlet region should not be compressed, thus adjust desk and seating height.
Frequent pauses are necessary to prevent extended strain on the upper limb muscles.
Minimize endothelial damage by using ultrasound guidance when inserting a pacemaker or central venous catheter.
For patients with persistent venous insufficiency or residual swelling, graduated compression sleeves can help relieve venous congestion.
Proper awareness about SVT should be provided and its related causes with management strategies.
Appointments with specialists and preventing recurrence of disorder is an ongoing life-long effort.
Surgery, Vascular
Warfarin:
It lowers the synthesis of active clotting factors and depletes functional vitamin K stores.
Heparin:
It accelerates the rate at which antithrombin neutralizes specific active coagulation factors.
Anatomic abnormalities include congenital fibromuscular bands, shortening of the costoclavicular space due to shoulder depression, or abnormal subclavius or scalenus anterior.
Endoluminal stent placement to avoid stent breakage due to compression against the first rib.
Surgery, Other
In acute phase management, the goal is to prevent thrombus extension and reduce symptoms.
In subacute phase management, the goal is to prevent recurrence and promote clot resolution.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional procedures.
The regular follow-up visits with the specialist are scheduled to check the improvement of patients along with treatment response.
In the subclavian vein, a main vein that drains blood from the upper limb toward the heart, a blood clot (thrombus) form.
The artery is located both superiorly and posteriorly to the subclavian vein, which runs over the first rib and behind the clavicle.
Subclavian vein thrombosis was initially reported by Sir James Paget in 1875. He named the spontaneous thrombosis of the veins draining the upper extremities “gouty phlebitis.”
Paget observed that the injured extremity swelled and hurt, but he mistakenly thought that the phenomenon was caused by vasospasm.
This syndrome, according to von Schrötter’s 1884 theory, was caused by occlusive thrombosis of the axillary and subclavian veins.
Hughes created the term Paget-von Schrötter syndrome in 1949 to honor the efforts of these pioneers. Indwelling catheters can cause thrombosis of the subclavian vein, which is a similar disease.
Due to the widespread use of central venous catheters (CVCs) in patients with cancer, renal failure, and other chronic medical illnesses, the incidence of this disorder has significantly increased over the past 20 years.
Axillary or subclavian vein thrombosis made about 1-2% of all deep vein thrombosis (DVT) cases prior to 1967.
Due to the increased use of central venous access for a variety of clinical problems the incidence has increased.
The dominant arm is where thrombosis occurs in 80% of patients with subclavian vein stenosis and effort-induced thrombosis.
Between 4% and 10% of all cases of deep vein thrombosis (DVT) are caused by UEDVT. The subclavian vein is one of the most impacted areas in UEDVT patients.
According to estimates, there are 1 to 2 cases of primary (effort-related) SVT per 100,000 persons each year mostly in young active people.
The internal jugular vein and femoral vein appear to have comparable thrombotic problems in hemodialysis patients.
Due to the extremely high risk of thrombosis, the subclavian vein should be avoided for both short-term and long-term hemodialysis.
This condition was dubbed “effort-induced thrombosis” in the 1960s to recognize that it occurs after exceptionally demanding usage of the afflicted side’s arm or shoulder.
It has been proposed that external compression of the axillary-subclavian vein plays a role in the blood stasis that causes thrombosis.
The subclavian vein’s venous flow is changed, and turbulence is increased when catheters and transvenous pacemakers are inserted.
It has documented that parenteral feeding and intravenous (IV) drugs can induce thrombophlebitis.
Primary SVT
Secondary SVT
Repetitive Upper Limb Activity
Central Venous Catheters
Pacemaker or Implantable Cardioverter-Defibrillator (ICD) Leads
Malignancy
Hypercoagulable States
The case fatality rate for untreated ASVT-related PE can reach 10%, which is like the rate for lower extremity PE.
Venous occlusion has long-term effects that include significant morbidity associated with chronic discomfort and swelling.
Physical activity that involves prolonged use of the afflicted arm might aggravate these sensations.
There is growing proof that endovascular procedures are the preferred treatment option for patients with upper-extremity thrombosis because of advancements in this technology.
This method facilitates a far quicker recovery and, over time, results in lower morbidity and fewer problem
A history of trauma or, more commonly, excessive arm use (>50% of cases) may be mentioned by patients. Frequently occurring triggering actions include backward and downward rotation of the shoulder or repetitive hyperabduction and external rotation of the arm.
Most patients arrive to the emergency department (ED) within 24 hours due to the relatively significant symptoms of subclavian stenosis.
Similar symptoms linked with the indwelling catheter in the ipsilateral arm or shoulder are reported by patients with catheter-related axillary-subclavian vein thrombosis (ASVT).
Palpation
Functional Tests
Systemic Examination
Acute symptoms are:
Swelling, pain or discomfort, Cyanosis or reddish discoloration of the arm, hand, or shoulder
Chronic symptoms are:
Sense of heaviness, tightness, or fatigue in the affected limb
Antiphospholipid Syndrome
Lymphedema
Pancoast Syndrome
Cellulitis
Superior Vena Cava Syndrome
Thrombolytic treatment is advised for patients whose effort-induced vein thrombosis has lasted less than two weeks.
Warfarin is a conservative treatment for chronic axillary-subclavian vein thrombosis (ASVT), and surgical bypass is an option if symptoms are severe.
Conservative care is the first line of treatment for subclavian vein thrombosis. This includes rest, limb elevation, and the use of warm compresses or heat.
Physical therapy is the initial treatment for a small number of individuals with no anatomic abnormalities and few symptoms.
Weight loss and adhesion release at the blockage site are two benefits of structured physical therapy.
Treatment approaches for Paget-von Schrötter syndrome and catheter-induced subclavian vein thrombosis differ based on their distinct natural history.
Thrombolytic therapy is favoured over thrombectomy due to the absence of surgical risks and the potential for an intimal tear caused by the embolectomy catheter.
The elimination of urokinase from the US market compelled interventional radiologists to use tissue plasminogen activator (tPA) in less clinically defined regimens.
Patients with catheter-associated subclavian thrombosis frequently have substantial comorbidity, care must be taken when choosing which individuals should receive thrombolytic therapy.
Surgery, Other
Adjust workstations or exercise regimens to reduce repeated or extended overhead activities.
The thoracic outlet region should not be compressed, thus adjust desk and seating height.
Frequent pauses are necessary to prevent extended strain on the upper limb muscles.
Minimize endothelial damage by using ultrasound guidance when inserting a pacemaker or central venous catheter.
For patients with persistent venous insufficiency or residual swelling, graduated compression sleeves can help relieve venous congestion.
Proper awareness about SVT should be provided and its related causes with management strategies.
Appointments with specialists and preventing recurrence of disorder is an ongoing life-long effort.
Surgery, Vascular
Warfarin:
It lowers the synthesis of active clotting factors and depletes functional vitamin K stores.
Heparin:
It accelerates the rate at which antithrombin neutralizes specific active coagulation factors.
Anatomic abnormalities include congenital fibromuscular bands, shortening of the costoclavicular space due to shoulder depression, or abnormal subclavius or scalenus anterior.
Endoluminal stent placement to avoid stent breakage due to compression against the first rib.
Surgery, Other
In acute phase management, the goal is to prevent thrombus extension and reduce symptoms.
In subacute phase management, the goal is to prevent recurrence and promote clot resolution.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional procedures.
The regular follow-up visits with the specialist are scheduled to check the improvement of patients along with treatment response.
Both our subscription plans include Free CME/CPD AMA PRA Category 1 credits.
Digital Certificate PDF
On course completion, you will receive a full-sized presentation quality digital certificate.
medtigo Simulation
A dynamic medical simulation platform designed to train healthcare professionals and students to effectively run code situations through an immersive hands-on experience in a live, interactive 3D environment.
medtigo Points
medtigo points is our unique point redemption system created to award users for interacting on our site. These points can be redeemed for special discounts on the medtigo marketplace as well as towards the membership cost itself.
Community Forum post/reply = 5 points
*Redemption of points can occur only through the medtigo marketplace, courses, or simulation system. Money will not be credited to your bank account. 10 points = $1.
All Your Certificates in One Place
When you have your licenses, certificates and CMEs in one place, it's easier to track your career growth. You can easily share these with hospitals as well, using your medtigo app.
