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Key Takeaway

Thoracic Outlet Syndrome is not just a neck or shoulder problem. It is a compression problem in a vital corridor that can affect nerves, blood vessels, and quality of life.

Chapter 12: Paget-Schroetter Syndrome

Chapter 12

Paget-Schroetter Syndrome

Blood Clots, Embolisms, and Death?

I’ll treat it with painkillers, and if it gets bad I’ll go to the doctor then.

—TOS patient

Don’t do this!

As you recall, Paget-Schroetter syndrome or effort thrombosis, is a complication of venous thoracic outlet syndrome that got out of control!

This is a condition where the compression of the vein in your shoulder gets so bad that a blood clot forms that blocks the blood flow out of your arm. This can get really scary, really fast.

If the clot breaks away from the vein, it can travel through the circulation all the way to your lung (pulmonary embolism) and cause what is called a lung infarction. This can lead to temporary or permanent difficulty breathing, or in some cases death.

Most doctors tell the nurse to get you to the operating room right away.

Not so fast... Read on...

Paget-Schroetter Syndrome or Effort Thrombosis

Effort thrombosis, or Paget-Schroetter syndrome, is an outcome of venous thoracic outlet syndrome that got much worse! It is when the compressed vein in your chest under your collarbone (axillary- subclavian vein) has a blood clot (thrombosis). This is usually associated with strenuous and repetitive activity of the upper extremities.

This is not thoracic outlet syndrome or a type of it. It is a complication of venous thoracic outlet syndrome. Venous thoracic outlet syndrome is caused by vein compression with or without a blood clot. Paget-Schroetter syndrome or effort thrombosis is caused by subclavian vein compression with a blood clot.

So if you have effort thrombosis, aka Paget-Schroetter syndrome, you have effort thrombosis (Paget- Schroetter syndrome) caused by thoracic outlet syndrome (1) (2).

If the blood clot (thrombus) releases to fl ow through the vein it is called an embolism. This embolism travels through the veins, to the heart. Then it is pumped out of the heart into the lung where it lodges in the more narrow branch(s) of the artery. This causes a blockage of blood fl ow causing the lung and the lung tissue in this area to die.

Incidence

Paget-Schroetter syndrome is often regarded as the most common vascular problem in athletes (4). Although more prevalent in male athletes, it is now increasingly affecting young women as they become seriously involved in athletics. Not surprisingly, effort thrombosis is more common in young and otherwise healthy men between the ages of 15–30. It preferentially involves the dominant arm (5).

Signs and Symptoms

The primary symptom is arm swelling, frequently accompanied by cyanosis, pain, and occasionally paresthesia (6). Cyanosis is a blue discoloration of the skin and mucous membranes resulting from inadequate oxygenation of the blood.

Symptoms can be excruciating deep pain the chest, shoulder, and entire upper extremity, accompanied by a feeling of heaviness that occurs especially after activity. The patient will present with cyanotic discoloration and distended collateral veins, potentially accompanied by edematous increases in the volume of the extremity (the arm is swollen) (7).

On the left side, an echogenic image is visualized with partial fl ow when seen with color Doppler, consistent with a thrombus (clot). Case courtesy of Dr. Luis Gerardo Tellez Martinez, Radiopaedia.org, rID: 35677 The incidence of upper extremity deep venous thrombosis (UEDVT) is increasing, partly due to the exponential growth in the use of central venous catheters and the increasing placement of permanent cardiac pacemaker or defibrillator devices (3).

Collateral veins form when the subclavian vein is narrowed or blocked. They form and widen to allow the blood to flow around the blocked subclavian vein. It would be similar to what happens when the main highway is blocked, so you get off the highway and take side streets. The side streets are the collateral veins.

Swelling and arm discomfort are the most frequent presenting problems. Other symptoms include heaviness, redness of arm, cyanosis, and dilated, visible veins across the shoulder and upper arm (Urschel’s sign) (1). Subclavian vein effort thrombosis can present itself as a rapid swelling of the entire arm, often with a blue discoloration, heaviness, and pain (8).

The symptoms of subclavian vein effort thrombosis are as follows.

  • A heaviness after activity
  • A deep pain in the chest
  • A cyanotic (blue) discoloration in the arms
  • A redness discoloration in the arms
  • Some distended and dilated collateral veins—Urschel’s sign
  • Some visible edema and swelling
  • Discomfort

Signs You Might Have Paget-Schroetter Syndrome

  • Arm swelling is usually substantial
  • Fatigue
  • Tightness
  • Heaviness
  • Pain in the arm, especially with use or overhead positioning Many who get this have enlarged veins in the upper arm, around the shoulders, or in the upper front of the chest wall.

Some people feel something simple, like they strained a muscle (9).

Cause

Effort thrombosis usually follows sporting activities, such as wrestling, playing ball, gymnastics, and swimming, which involve vigorous and sustained shoulder and arm movements (10). A majority of patients report a discrete precipitating event, usually sports-related arm exertion (10). Approximately 60–80 percent of patients diagnosed with Paget-Schroetter syndrome report a history of repetitive or vigorous overhead activity (20). Occasionally, minor, relatively innocuous day-to-day, activities can precipitate effort thrombosis (10) (1).

Anatomical abnormalities at the thoracic outlet and repetitive trauma to the outer covering of the vein of the subclavian vein are key factors in its starting and getting progressively worse (5). It is believed that the full backward rotation of the arm in a pitching motion imposes undue strain on the subclavian vein, leading to microtrauma of the covering of the vein and activation of the clotting of the blood (5). When the shoulder complex is pulled or dragged down into the thoracic outlet, the costoclavicular space between the ribs and the collarbone become narrower. This can cause a compression of the vein and slow the flow of the blood through the vein. Also, when the space is so narrowed, the blood vessels and nerves are more at risk to be damaged when you move your shoulder and arms.

This can lead to a more constant irritation and trauma to the cell wall of the vein causing inflammation and scar tissue formation. This can cause even more narrowing of the costoclavicular space causing even more compression of the vein (5). It can arise as a consequence of compression and repetitive injury of the subclavian vein between the first rib and the collarbone, in addition to the anterior scalene muscle, subclavius muscle, and costoclavicular ligament (8). Subclavian vein (SCV) effort thrombosis is considered primarily a “mechanical” condition caused by compression and irritation of the vein, and, unlike other forms of clotting or deep vein thrombosis (DVT) in the legs, it is not associated with inactivity, obesity, advanced age, underlying coagulation disorders, surgery, or trauma (8). The blood flow can also be reduced, causing a clot to form in the costoclavicular space or subpectoral space. With repetition during a long period of time, this type of focal venous injury leads to progressive scarring and narrowing of the subclavian vein at the level of the first rib, along with scar tissue formation and contraction around the outside of the vein, in addition to scar tissue and narrowing that happens within the inside wall of the vein (8).

You can get a blood clot that results from stagnant and turbulent blood flow in the narrowed segment of the subclavian vein (8). The movement of this clot upstream in the subclavian vein into the axillary vein can then result in further obstruction of critical collateral veins, resulting in the acute clinical presentation of the (blood clot) effort thrombosis syndrome (8).

What activities or conditions put you at greater risk for Paget-Schroetter syndrome?

Thrombophilia is a condition where your blood has an increased risk to form blood clots (11). It’s not certain if oral contraceptives can put you at risk for blood clots in the subclavian vein (12) (13)

(14) (15) (16) (17), but their role in lower leg blood clots (18) and blood clots in the brain (N ) is well established. Pregnant women have a higher than average risk for blood clots.

Might Be Missed or Misdiagnosed

According to Perlowski and Jaff, vascular issues are commonly overlooked in athletes for three main reasons (19).

  • The first reason is that most athletes are often young and healthy.
  • The second reason is that their symptoms might be similar to, and therefore mistaken for, a musculoskeletal injury.
  • The third reason is that many healthcare practitioners might not adequately perform a vascular examination and are unaware of Paget-Schroetter syndrome as a differential diagnosis.

If you get a clot in your vein and you wait too long, the results might not be so good. It’s better to get treated immediately (20) (21) (22).

A blood clot can release and flow through the circulatory system into the heart, then into the lungs and damage them permanently. This happens in approximately 12 percent of those with Paget-Schroetter syndrome. Overall mortality (death) rate for patients with pulmonary embolism is approximately 15– 50 percent (2) (1) (8).

What part of Paget-Schroetter syndrome scares you into getting your thoracic outlet syndrome treated immediately before it gets worse? If you get Paget-Schroetter syndrome, can I still treat you? Yes, however you MUST first get the clot dissolved.

After the clot is dissolved, your doctor will usually want to surgically remove the scalene muscles and first rib within 24 hours of the clot being dissolved. However, in some cases, the doctor might not opt for the full decompression surgery.

If you decide not to have the surgery and treat the thoracic outlet syndrome with the recommendations in this book, I recommend you read this book through and make sure your doctor is following the recommendations exactly. You can call me if you wish to talk this through.

It is important to understand that if you don’t get treated for thoracic outlet syndrome that the risk of pulmonary embolism with effort thrombosis is real and significant (5).

This photo was taken from a video showing surgery for thoracic outlet syndrome. The structure on the left is the scalene muscle that was surgically removed, and the structure on the right is the fi rst rib that was surgically removed.

The possibility that you could get Paget-Schroetter syndrome is fairly rare. So while you should not leave thoracic outlet syndrome go you also should not run to the local vascular surgeon and ask for surgery.

Management

The Former Way

The short-term and long-term goals of treatment for SCV effort thrombosis are fourfold (4).

  1. To provide prompt relief of acute upper extremity symptoms and prevent pulmonary embolism (obstruction of an artery).
  2. To reduce the likelihood of recurrent venous thrombosis (blood clotting in the veins) following initial management.
  3. To diminish or prevent the potential development of upper extremity post-thrombotic
  4. To return to normal unrestricted use of the upper extremity without the need for chronic anticoagulation and other medications. For many years, patients with effort thrombosis were managed conservatively with limb elevation and anticoagulation (23).

Systemic fibrinolysis is superior to anticoagulation in achieving vein patency but is associated with higher rates of complications such as intracranial hemorrhage (23). Fibrinolysis is a process that prevents blood clots from getting larger and causing further problems.

Catheter Directed Thrombolysis

Treatment

  • Limb elevation
  • Local catheter-directed thrombolysis (drugs are used to dissolve blood clots)
  • Fibrinolytic agent (clot-dissolving drug)
  • Remove the extrinsic compression (thoracic outlet surgery)
  • Remove the intrinsic stenosis (cut out part of the vein that is narrowed)
  • Vein patch angioplasty (patch that part of the vein)
  • Percutaneous angioplasty (mechanically widen narrowed or obstructed arteries)
  • Subclavian vein narrowing, requiring balloon angioplasty

The Current Way

Treatment with an antiplatelet (anticlotting) agents, such as aspirin or clopidogrel, is often initiated.

The goal of thrombolysis (clot dissolving) is to clear any fresh or recent clot from the axillary and subclavian veins, along with any blocked smaller veins in the area passing through the thoracic outlet space. This usually results in a marked improvement in the appearance of the subclavian vein and a prompt reduction in symptoms of venous obstruction (24). In most cases, thrombolytic therapy is able to effectively dissolve the clot (25).

It is most effective when given within one week of the onset of symptoms, but might be effective up to one month after symptoms develop (26). Long-term anticoagulation might therefore be needed to reduce the potential for recurrent venous thrombosis (27). Most patients require prolonged infusion of the fibrinolytic agent for catheter-directed thrombolysis; average durations vary 24–48 hours (28).

It is notable that there is still a significant risk of recurrent thrombosis following thrombolysis and anticoagulation, with estimates ranging from 50–70 percent (8).

Sometimes nonsurgical management with anticoagulation alone is inadequate and leaves the person unable to function. In these cases, doctors must remove the clot with a local catheter-directed thrombolysis (clot-buster). Surgical treatment, therefore, should be considered in almost all patients with venous TOS and SCV effort thrombosis as the most definitive management approach (8).

Some professionals think that local, catheter-directed thrombolysis has the therapeutic value of systemic thrombolysis without significant systemic side effects. This treatment is recommended in all patients presenting early (28). Doctors refer to this as injecting clot-busters. Others think that a catheter-directed thrombolysis is associated with several disadvantages, including major systemic hemorrhage (25) (29).

Some professionals recommend a conservative approach to remove the extrinsic compression. Soft tissue therapy of the musculature surrounding the costoclavicular space and the shoulder girdle might help to decrease the compression of the subclavian vein. Postural education and correction of abnormal shoulder biomechanics through scapular stabilization, manipulation, or mobilization of the thoracic spine, costovertebral, sternoclavicular, or acromioclavicular joints might also help to prevent the recurrence or persistent symptoms of (24).

Damaged veins are repaired by either endovascular or open techniques (30). After surgery, vein patch angioplasty or venous bypass might be required to restore normal circulation (24). Current estimates indicate that 40–50 percent of patients will demonstrate a residual subclavian vein stenosis, narrowing of the vein. You might be required to get a balloon angioplasty, even several weeks after the first rib resection. Because these narrowed areas are typically composed of dense scar tissue within and around the wall of the vein, balloon angioplasty might be relatively ineffective in this setting. Although placement of subclavian vein stents might be considered, the long-term effectiveness of stents in this position is questionable. However, balloon angioplasty is often unsuccessful in this setting, because the vein is obstructed by scar tissue and external compression between the clavicle and first rib. However, even when improvement is obtained, it is usually short lived (8).

Surgical thrombectomy, balloon venoplasty, and stenting have practically been abandoned due to the limited success, high procedural morbidity (death), and high rates of stent fracture (25).

Thoracic Outlet Surgery

The paraclavicular approach combines the advantages of the supraclavicular exposure used for neurogenic and arterial forms of TOS with an infraclavicular incision that permits complete resection of the medial first rib and wide exposure of the SCV to permit vascular reconstruction (26).

Residual subclavian vein stenosis after operative thoracic outlet decompression is common in patients with venous thoracic outlet syndrome (31). Once the extrinsic compression has been relieved, damaged veins might be repaired surgically (32). In some cases, the veins can be patched, or a vein bypass to go around the damaged area of the vein might be required to restore normal circulation (32).

However, the Society for Vascular Medicine (SVM) asks surgeons to refrain from percutaneous or surgical revascularization of peripheral artery stenosis in patients without claudication, which is pain, discomfort, or tiredness that happens when they move or have critical limb ischemia (a sudden lack of blood flow to a limb). SVM says that no evidence exists to support improving circulation to prevent progression of disease. There is no proven preventive benefit, only symptomatic benefit. With proper surgical care, acute limb ischemia is a treatable condition. If it is not caught in time, it can result in disease, amputation, and/or death. One might require an amputation from toxins that buildup from the cells dying, because they could not get oxygen due to the blockage of blood flow to them.

Surgery

A lot of doctors are reactive when they have a patient with Paget-Schroetter syndrome. This is why they cut out the scalene muscles, pectoralis minor muscle, and first rib. Then they follow that with a nonsurgical procedure, percutaneous angioplasty, used to treat the narrowed arteries.

Serious problems can result from untreated Paget-Schroetter syndrome, including blood clots that form and release into the lungs.

After Surgery

Postoperative care for patients undergoing surgical interventions includes ample use of pain medications, muscle relaxants, and anti-inflammatory agents. Therapeutic anticoagulation (heparin/ warfarin), with or without adjunctive antiplatelet therapy (aspirin or clopidogrel), is initiated several days after the operation and then discontinued at 12 weeks (8).

The expected postoperative hospital stay is five to six days, with a drain removed six to seven days after the operation (8).

Inpatient physical therapy is started the day after the operation to maintain range of motion, with postoperative rehabilitation then overseen by a physical therapist with expertise in the management of TOS. No restrictions are placed on upper extremity activity 12 weeks after surgery (8). Full recovery is typically complete within three months of the operation, and a return to previous levels of functional activity can usually be expected (8).

Sometimes a clot releases into the lung after surgery, and this could be a big problem. Doctors call it a pulmonary embolism. The key signs and symptoms of a pulmonary embolism include dyspnea, chest pain, syncope, low-grade fever, and racing heart rate (33–34). It only happens with 5.6 percent of patients, which is rare for Paget-Schroetter syndrome. However, a pulmonary embolism is a serious complication that might result in a fatal outcome, reinforcing the importance of a proper diagnosis (33–34).

Is it possible to just dissolve the clot and prevent another clot from forming without thoracic outlet surgery?

The role of thoracic outlet decompression in the treatment of primary axillary-subclavian vein thrombosis remains controversial. (35)

There was a group of doctors from Stanford University School of Medicine, led by Dr. Lee, who did not elect to do immediate surgery after they dissolved the blood clot in the subclavian artery. They put the patients on anticoagulants for three months and waited to see if the clot returned. (35)

After a month, they determined if the patient needed surgery. The indications for surgery were simple:

  1. Persistence or recurrence of symptoms of increased blood pressure in the veins due to obstruction or narrowing.
  2. Positional obstruction or blocking of the collateral veins with blood clots in the axillary- subclavian vein noted in the venography.
  3. Evidence of a blood clot or a pulmonary embolus.

They had 22 patients in the study.

Thirteen had surgery after the blood clot was dissolved. Of the 13 who had surgery, 11 of these patients returned to their same physical activity as before the surgery (35).

Nine patients did not have surgery after the blood clot was dissolved. Of these nine who did not have surgery, eight of these patients returned to their same physical activity as before the surgery.

What is important to note is that not all patients who have a blood clot in the subclavian vein will require surgery. However, these doctors selected the ones most likely to recover without surgery.

The other important fact is that these doctors only treated the patients with anticoagulants. They did not get any physical therapy. I’m sure the results would have been even better if the nine patients treated without surgery got treated with my human spring, nonsurgical approach to thoracic outlet decompression (35).

What part of Paget-Schroetter syndrome scares you into getting your thoracic outlet syndrome treated immediately before it gets worse? If you get Paget-Schroetter syndrome, can I still treat you?

Yes, however you MUST first get the clot dissolved. After the clot is dissolved, your doctor will want to surgically decompress the thoracic outlet. However, the thoracic outlet can be decompressed with treatment outlined in this book. In some cases, it might be a tough case where you need some extra help.

Feel free to contact me. It would be an honor to help you regain your health!

Summary

If you would like a second opinion on your case with the focus on the results of your diagnostic tests, go to www.thoracicoutletsyndrome.org, or www.drstoxen.com to register for an online consultation, then submit a scan of your MRI report and other medical data. We will give you a second opinion.

You do not want to get surgery for thoracic outlet syndrome unless you contact me fi rst. Call me at 773 735-5200 and lets talk this over.

Frequently Asked Questions

What is Paget-Schroetter syndrome?

Paget-Schroetter syndrome is a form of venous thoracic outlet syndrome (TOS) in which compression of the subclavian vein leads to the formation of a blood clot, also called effort thrombosis. It most commonly occurs after repetitive overhead activity, heavy lifting, or strenuous arm use in people with a narrowed thoracic outlet.

Symptoms usually include sudden arm swelling, heaviness, discoloration, pain, and enlarged superficial veins. Throughout this book, you will learn how Human Spring biomechanics influence Paget-Schroetter syndrome and why early diagnosis is essential.

What is effort thrombosis?

Effort thrombosis is the formation of a blood clot within the subclavian vein following repetitive arm activity or heavy upper-extremity exertion. It is most commonly associated with venous thoracic outlet syndrome (TOS) because repeated compression damages the vein and promotes clot formation.

Effort thrombosis is considered a medical emergency that requires prompt evaluation and treatment. Throughout this book, you will learn why restoring normal Human Spring biomechanics may help reduce the mechanical factors that contribute to effort thrombosis.

What are Paget-Schroetter syndrome symptoms?

The most common Paget-Schroetter syndrome symptoms include sudden swelling of one arm, heaviness, bluish discoloration, pain, tightness, enlarged superficial veins, and fatigue with arm use. These symptoms occur because effort thrombosis blocks normal venous blood flow through the subclavian vein.

Symptoms frequently develop after strenuous upper-body exercise or repetitive overhead activity. Throughout this book, you will learn how to recognize Paget-Schroetter syndrome and why immediate medical evaluation is important.

What is venous thoracic outlet syndrome (TOS)?

Venous thoracic outlet syndrome (TOS) occurs when the subclavian vein becomes compressed within the thoracic outlet, reducing normal blood flow from the arm. Patients commonly develop swelling, heaviness, discoloration, prominent superficial veins, and, in severe cases, effort thrombosis (Paget-Schroetter syndrome).

Venous thoracic outlet syndrome (TOS) is much less common than neurogenic thoracic outlet syndrome but requires prompt recognition because of its vascular complications. Throughout this book, you will learn how Human Spring biomechanics influence venous thoracic outlet syndrome (TOS) and its treatment.

What is arterial thoracic outlet syndrome (TOS)?

Arterial thoracic outlet syndrome (TOS) occurs when the subclavian artery becomes compressed within the thoracic outlet, reducing blood flow to the arm and hand. Patients may develop coldness, hand fatigue, pain, diminished pulses, color changes, aneurysms, or arterial emboli.

Arterial thoracic outlet syndrome (TOS) is the rarest form of thoracic outlet syndrome but carries the greatest risk of serious vascular complications. Throughout this book, you will learn how to recognize arterial thoracic outlet syndrome (TOS) and when urgent treatment is necessary.

Can thoracic outlet syndrome (TOS) cause blood clots?

Yes. Thoracic outlet syndrome (TOS) can cause blood clots when compression of the subclavian vein damages the vessel and slows blood flow, leading to effort thrombosis (Paget-Schroetter syndrome).

This complication occurs almost exclusively in venous thoracic outlet syndrome and usually follows repetitive overhead activity or strenuous upper-body exercise. A blood clot associated with thoracic outlet syndrome (TOS) requires immediate medical evaluation.

Throughout this book, you will learn how vascular compression contributes to clot formation and why early diagnosis is essential.

Can thoracic outlet syndrome (TOS) cause swelling?

Yes. Thoracic outlet syndrome (TOS) can cause swelling, particularly when compression affects the subclavian vein and interferes with normal venous drainage from the arm.

Swelling is most common in venous thoracic outlet syndrome, but muscle inflammation and soft tissue congestion may also contribute to milder swelling in other forms of thoracic outlet syndrome. Sudden or severe swelling should always be evaluated promptly because it may indicate effort thrombosis.

Throughout this book, you will learn why swelling is an important warning sign of thoracic outlet syndrome (TOS).

Can thoracic outlet syndrome (TOS) affect circulation?

Yes. Thoracic outlet syndrome (TOS) can affect circulation when compression involves the subclavian artery or subclavian vein, reducing normal blood flow into or out of the arm.

Circulatory symptoms may include coldness, color changes, swelling, heaviness, fatigue, diminished pulses, or delayed capillary refill. These symptoms are most common in vascular thoracic outlet syndrome but may occasionally accompany severe neurogenic compression.

Throughout this book, you will learn how vascular involvement changes the diagnosis and treatment of thoracic outlet syndrome (TOS).

Can thoracic outlet syndrome (TOS) cause one arm to become cold?

Yes. Thoracic outlet syndrome (TOS) can cause one arm to become cold when compression reduces blood flow through the subclavian artery.

The affected hand may also become pale, weak, painful, or fatigued during activity because of decreased arterial circulation. A persistently cold arm should always be evaluated because it may indicate arterial thoracic outlet syndrome or another serious vascular condition.

Throughout this book, you will learn why changes in arm temperature are important signs of thoracic outlet syndrome (TOS).

Can thoracic outlet syndrome (TOS) cause aneurysm?

Yes. Thoracic outlet syndrome (TOS) can cause a subclavian artery aneurysm when chronic arterial compression repeatedly damages the arterial wall.

Over time, this injury may weaken the artery and increase the risk of clot formation or distal embolization. Arterial aneurysms occur primarily in arterial thoracic outlet syndrome, which is relatively uncommon.

Throughout this book, you will learn how chronic arterial compression contributes to aneurysm formation in thoracic outlet syndrome (TOS).

Can thoracic outlet syndrome (TOS) cause embolism?

Yes. Thoracic outlet syndrome (TOS) can cause an embolism when a blood clot forms within a damaged subclavian artery or subclavian vein and fragments travel through the circulation.

Arterial emboli may reduce blood flow to the hand and fingers, while venous clots carry different risks depending on their location. Although embolic complications are uncommon, they represent serious forms of vascular thoracic outlet syndrome.

Throughout this book, you will learn how vascular compression increases the risk of embolism in thoracic outlet syndrome (TOS).

Can thoracic outlet syndrome (TOS) cause stroke?

Thoracic outlet syndrome (TOS) does not commonly cause stroke. In rare cases of arterial thoracic outlet syndrome, clot formation within the subclavian artery may lead to embolic complications, but stroke resulting directly from thoracic outlet syndrome is extremely uncommon.

Most patients with thoracic outlet syndrome (TOS) never experience this complication. Throughout this book, you will learn which vascular complications are common, which are rare, and when urgent medical evaluation is necessary.

What vascular complications occur with thoracic outlet syndrome (TOS)?

The major vascular complications of thoracic outlet syndrome (TOS) include effort thrombosis (Paget-Schroetter syndrome), subclavian vein thrombosis, subclavian artery aneurysm, arterial embolism, chronic venous obstruction, arm swelling, impaired circulation, and hand ischemia. These complications occur primarily in venous and arterial thoracic outlet syndrome rather than neurogenic thoracic outlet syndrome.

Early recognition greatly improves treatment outcomes and reduces long-term disability. Throughout this book, you will learn how to recognize the vascular complications associated with thoracic outlet syndrome (TOS).

When is vascular testing necessary for thoracic outlet syndrome (TOS)?

Vascular testing is necessary when thoracic outlet syndrome (TOS) is suspected to involve the subclavian artery or subclavian vein, particularly in patients with swelling, discoloration, coldness, diminished pulses, prominent veins, or suspected effort thrombosis. Dynamic testing performed in symptom-producing arm positions is often more informative than studies performed only at rest.

Common studies include dynamic Doppler ultrasound, duplex ultrasound, CTA, MRA, venography, and arteriography. Throughout this book, you will learn when vascular testing is indicated and how it contributes to diagnosing thoracic outlet syndrome (TOS).

When is vascular surgery necessary for thoracic outlet syndrome (TOS)?

Vascular surgery is necessary when thoracic outlet syndrome (TOS) causes significant arterial or venous injury, including effort thrombosis, arterial aneurysm, arterial embolism, severe arterial insufficiency, or persistent venous obstruction. The goal of surgery is to restore normal blood flow, prevent permanent vascular damage, and reduce the risk of recurrent complications.

Only a small percentage of patients with thoracic outlet syndrome (TOS) require vascular surgery because most patients have the neurogenic form of the disorder. Throughout this book, you will learn which vascular conditions require surgery and which patients can often be managed with appropriate conservative treatment.

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Glossary

Browse important terms used in this chapter. Select a letter or search by keyword.

A Acromioclavicular (AC) Joint
The joint between the acromion of the scapula and the clavicle. The chapter discusses restoring AC joint mobility through conservative manual therapy to improve shoulder biomechanics and reduce venous compression.
A Acute Limb Ischemia
A sudden reduction or loss of arterial blood flow to an extremity. Although uncommon in Paget-Schroetter syndrome, acute limb ischemia is a vascular emergency requiring immediate treatment to prevent tissue death or amputation.
A Alteplase
A thrombolytic ("clot-busting") medication used during catheter-directed thrombolysis to dissolve blood clots in the subclavian vein.
A Anterior Scalene Muscle
One of the primary muscles contributing to compression of the subclavian vein within the thoracic outlet. Chronic contraction narrows the costoclavicular space and contributes to Paget-Schroetter syndrome.
A Anticoagulant Therapy
Treatment with medications that reduce the blood's ability to clot. Anticoagulants are routinely prescribed after thrombolysis to reduce recurrent thrombosis.
A Antiplatelet Therapy
Medication that reduces platelet aggregation and decreases clot formation. Aspirin and clopidogrel are examples discussed in the chapter.
A Arterial Thoracic Outlet Syndrome (ATOS)
The vascular form of thoracic outlet syndrome caused by compression of the subclavian artery, potentially leading to arterial insufficiency, aneurysm formation, or embolism.
A Arteriography
An imaging study using contrast dye to visualize arteries and evaluate arterial compression or obstruction.
A Arm Edema
Swelling of the upper extremity caused by impaired venous drainage. Arm edema is one of the hallmark findings in Paget-Schroetter syndrome.
A Arm Heaviness
A sensation of increased weight or fatigue in the affected arm resulting from impaired venous return and venous congestion.
A Axillary-Subclavian Vein
The venous segment extending from the axillary vein to the subclavian vein beneath the clavicle. Compression of this vessel produces venous thoracic outlet syndrome and Paget-Schroetter syndrome.
A Axillary Vein
The major vein draining the upper extremity before becoming the subclavian vein. Thrombosis may extend into or originate within this vessel.
B Balloon Angioplasty
A catheter-based procedure using an inflatable balloon to widen a narrowed vein after thrombolysis or surgery. The chapter notes that long-term effectiveness may be limited because of persistent scar tissue and external compression.
B Blood Clot (Thrombus)
A mass of coagulated blood that obstructs normal circulation. In Paget-Schroetter syndrome, the clot develops within the compressed subclavian vein.
B Brachial Plexus
The network of nerves supplying the upper extremity. Although Chapter 12 primarily focuses on venous compression, brachial plexus compression often accompanies severe thoracic outlet narrowing.
C Capillary Refill
A clinical assessment of peripheral circulation measuring how quickly blood returns after blanching the skin. Delayed capillary refill may indicate arterial thoracic outlet syndrome.
C Cardiac Pacemaker
An implanted cardiac rhythm device recognized as an increasing cause of upper-extremity deep vein thrombosis because of central venous instrumentation.
C Catheter-Directed Thrombolysis
A minimally invasive procedure in which clot-dissolving medication is delivered directly into a blood clot through a catheter to restore venous blood flow. It represents the current standard treatment for acute Paget-Schroetter syndrome.
C Central Venous Catheter (CVC)
A catheter inserted into a major vein for medical treatment. Increased use of CVCs has contributed to the rising incidence of upper-extremity deep vein thrombosis.
C Claudication
Pain, fatigue, or discomfort during activity caused by inadequate blood flow. The Society for Vascular Medicine recommends against certain revascularization procedures in patients without claudication or critical limb ischemia.
C Clopidogrel (Plavix®)
An antiplatelet medication commonly prescribed after thrombolysis or surgery to reduce the risk of recurrent thrombosis.
C Collateral Circulation
Alternative venous pathways that enlarge to bypass an obstructed subclavian vein. Development of collateral circulation is a characteristic feature of Paget-Schroetter syndrome.
C Collateral Veins
Enlarged superficial veins that develop to bypass obstruction of the subclavian vein. Their presence is an important clinical sign of chronic venous obstruction.
C Costoclavicular Compression
Mechanical narrowing between the clavicle and first rib that compresses the subclavian vein. The chapter identifies this as one of the primary biomechanical causes of Paget-Schroetter syndrome.
C Costoclavicular Ligament
A ligament connecting the clavicle to the first rib. Along with surrounding muscles, it contributes to narrowing of the costoclavicular space during venous thoracic outlet syndrome.
C Costoclavicular Space
The anatomical space between the clavicle and first rib through which the subclavian vein passes. Progressive narrowing of this space contributes directly to venous thoracic outlet syndrome and Paget-Schroetter syndrome.
D Deep Vein Thrombosis (DVT)
The formation of a blood clot within a deep vein. In Chapter 12, DVT primarily refers to upper-extremity deep vein thrombosis (UEDVT) involving the subclavian or axillary vein in Paget-Schroetter syndrome.
D Diagnostic Imaging
Medical imaging studies such as ultrasound, CT, MRI, venography, CTA, and MRA used to evaluate vascular compression, thrombosis, and thoracic outlet anatomy.
D Distended Collateral Veins
Enlarged superficial veins that become visible when blood is diverted around an obstructed subclavian vein. They are a characteristic clinical finding in Paget-Schroetter syndrome.
D Dominant Upper Extremity
The arm used preferentially for daily activities. Paget-Schroetter syndrome most commonly affects the dominant arm because of greater repetitive mechanical loading.
D Doppler Ultrasound
A vascular ultrasound technique that measures blood flow within arteries and veins. Dynamic Doppler ultrasound is commonly used to evaluate vascular thoracic outlet syndrome.
D Duplex Ultrasound
A diagnostic examination combining traditional ultrasound imaging with Doppler blood-flow analysis to evaluate the subclavian artery and vein.
D Dyspnea
The medical term for shortness of breath. Dyspnea is a major symptom of pulmonary embolism and other pulmonary complications associated with Paget-Schroetter syndrome.
E Edema
Abnormal accumulation of fluid within tissues resulting in swelling. Upper-extremity edema is one of the hallmark findings of Paget-Schroetter syndrome.
E Embolism
Obstruction of a blood vessel by material—usually a blood clot—that has traveled through the circulation from another location.
E Endothelial Injury
Damage to the inner lining of a blood vessel. Repetitive compression of the subclavian vein causes endothelial injury that initiates clot formation.
E Endovascular Surgery
Minimally invasive vascular procedures performed through catheters placed within blood vessels to repair or reconstruct damaged veins.
E Effort Thrombosis
Another name for Paget-Schroetter syndrome, referring to thrombosis of the subclavian vein following repetitive upper-extremity exertion or overhead activity.
E Erythema
Red discoloration of the skin resulting from increased blood flow or vascular congestion. The affected arm may appear red in venous thoracic outlet syndrome.
E Extrinsic Compression
Mechanical compression applied from outside the blood vessel by surrounding muscles, bones, or ligaments. Extrinsic compression is the primary mechanism responsible for subclavian vein obstruction in Paget-Schroetter syndrome.
F Fatigue
A feeling of exhaustion or reduced endurance of the affected upper extremity due to impaired venous return. Fatigue commonly accompanies arm swelling and heaviness.
F Fibrinolysis
The physiological or medically induced breakdown of blood clots by fibrinolytic enzymes or medications. Catheter-directed fibrinolysis is a principal treatment for Paget-Schroetter syndrome.
F Fibrinolytic Agents
Clot-dissolving medications used during thrombolytic therapy to restore blood flow through an obstructed vein.
F Fibrosis
Formation of dense scar tissue following chronic inflammation or injury. Progressive fibrosis narrows the subclavian vein and contributes to recurrent venous obstruction.
F First Rib
The superior-most rib forming the floor of the thoracic outlet. Elevation of the first rib narrows the costoclavicular space and contributes to subclavian vein compression.
F First Rib Resection
Surgical removal of the first rib performed to enlarge the thoracic outlet and reduce compression of the subclavian vein in selected patients with Paget-Schroetter syndrome.
G Gymnastics
An overhead sport associated with repetitive shoulder loading and an increased risk of developing Paget-Schroetter syndrome.
H Heparin
An anticoagulant ("blood thinner") commonly administered after thrombolysis or surgery to reduce the risk of recurrent blood clot formation.
H Hemorrhage
Excessive bleeding resulting from injury or complications of thrombolytic therapy or vascular procedures. Hemorrhage is a recognized risk of systemic fibrinolysis.
H Hemorrhagic Complications
Bleeding complications associated with thrombolytic medications or anticoagulant therapy.
H Human Spring Approach
The author's conservative biomechanical treatment system emphasizing restoration of muscle tone, posture, shoulder mechanics, first rib position, and venous decompression without surgery whenever appropriate.
H Hypercoagulability
An increased tendency of the blood to clot. Hypercoagulable states are discussed as potential—but less common—risk factors for upper-extremity deep vein thrombosis.
H Hypertension (Venous Hypertension)
Elevated pressure within the venous system caused by obstruction of venous outflow. Venous hypertension may persist after thrombolysis and influence the decision for surgery.
I Implantable Cardioverter-Defibrillator (ICD)
An implanted cardiac device recognized as a growing cause of upper-extremity deep vein thrombosis because of chronic central venous instrumentation.
I Implantable Vascular Device
A medical device placed within the vascular system that may increase the risk of upper-extremity venous thrombosis.
I Incidence
The frequency with which a disease or condition occurs within a population. The chapter discusses the increasing incidence of upper-extremity deep vein thrombosis.
I Inflammation
The body's biological response to injury. Chronic inflammation of the subclavian vein contributes to fibrosis, narrowing, and eventual thrombosis.
I Infraclavicular Incision
A surgical incision made below the clavicle to expose the subclavian vein during vascular reconstruction procedures.
I Infraclavicular Surgical Approach
A surgical approach beneath the clavicle providing wide exposure of the subclavian vein for venous repair and reconstruction.
I Inherited Coagulation Disorders
Genetic abnormalities affecting blood clotting that increase thrombotic risk. The chapter notes these disorders are generally less important causes of Paget-Schroetter syndrome than mechanical compression.
I Intracranial Hemorrhage
Bleeding within the skull or brain. Intracranial hemorrhage is one of the most serious complications associated with systemic fibrinolytic therapy.
I Intrinsic Venous Stenosis
Narrowing occurring within the wall or lumen of the subclavian vein itself, often requiring surgical repair or reconstruction.
J Joint Mobilization
A manual therapy technique designed to restore normal joint motion. The chapter recommends mobilization of the thoracic spine, sternoclavicular joint, acromioclavicular joint, and costovertebral joints to improve shoulder biomechanics and reduce venous compression.
K Kinking of the Subclavian Vein
Abnormal bending or angulation of the subclavian vein produced by narrowing of the thoracic outlet, contributing to impaired venous blood flow and thrombosis.
L Limb Elevation
Raising the affected arm above heart level to reduce swelling and improve venous return. Limb elevation was historically one of the primary conservative treatments for Paget-Schroetter syndrome.
L Lung Infarction (Pulmonary Infarction)
Death of lung tissue caused by obstruction of pulmonary blood flow following pulmonary embolism. Pulmonary infarction represents one of the most serious complications of untreated Paget-Schroetter syndrome.
L Lymphatic Drainage
Movement of lymphatic fluid from tissues back into the circulation. Although Chapter 12 primarily focuses on venous drainage, restoration of normal lymphatic and venous flow contributes to reducing arm swelling.
M Manual Manipulation
A hands-on treatment technique used to restore normal joint alignment and biomechanics. The chapter includes manual manipulation as part of conservative treatment to reduce venous compression within the thoracic outlet.
M Manual Therapy
Hands-on treatment directed toward muscles, fascia, joints, and soft tissues to reduce subclavian vein compression, restore shoulder mechanics, and improve venous drainage without surgery.
M Mechanical Compression Disorder
A condition in which symptoms result primarily from physical compression of anatomical structures rather than systemic disease. The chapter describes Paget-Schroetter syndrome as primarily a mechanical compression disorder of the subclavian vein.
M Microtrauma
Repeated microscopic injury to tissues resulting from chronic mechanical stress. Microtrauma to the endothelial lining of the subclavian vein initiates inflammation and thrombosis.
M Movement Dysfunction
Abnormal movement patterns involving the shoulder girdle and upper extremity that contribute to thoracic outlet narrowing and venous compression.
M Movement-Based Rehabilitation
A rehabilitation strategy emphasizing restoration of normal biomechanics, posture, and functional movement following treatment for Paget-Schroetter syndrome.
M Magnetic Resonance Angiography (MRA)
A magnetic resonance imaging technique used to visualize arteries and veins without conventional catheter angiography. MRA is recommended when evaluating vascular thoracic outlet syndrome.
M Magnetic Resonance Imaging (MRI)
A diagnostic imaging technique that produces detailed images of soft tissues, nerves, muscles, and blood vessels. MRI findings may contribute to the evaluation of thoracic outlet syndrome.
N Necrosis
Death of living tissue resulting from prolonged oxygen deprivation. Severe vascular obstruction may ultimately produce tissue necrosis requiring amputation.
N Neurovascular Compression
Simultaneous compression of nerves and blood vessels within the thoracic outlet. Although Paget-Schroetter syndrome primarily affects the subclavian vein, neurovascular compression often coexists.
N Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
A class of medications commonly prescribed after surgery to reduce pain and inflammation during postoperative recovery.
O Oral Contraceptives
Birth control medications containing estrogen and/or progestin. The chapter discusses oral contraceptives as a possible contributing risk factor for thrombosis, although their role in Paget-Schroetter syndrome remains uncertain.
O Overhead Activity
Repetitive arm movements performed above shoulder height. Overhead activity is one of the strongest mechanical risk factors for developing Paget-Schroetter syndrome.
O Overhead Athletic Activity
Sports requiring repetitive overhead arm motion, such as baseball, swimming, volleyball, gymnastics, and wrestling. These activities increase mechanical stress on the subclavian vein.
O Overuse Injury
Musculoskeletal or vascular injury resulting from repetitive stress without adequate recovery. Paget-Schroetter syndrome is commonly associated with upper-extremity overuse injuries.
P Paget-Schroetter Syndrome
Also known as effort thrombosis, primary upper-extremity deep vein thrombosis, or subclavian vein thrombosis, Paget-Schroetter syndrome is a complication of venous thoracic outlet syndrome in which chronic compression of the subclavian vein produces thrombosis.
P Paresthesia
An abnormal sensation such as tingling, numbness, or pins-and-needles resulting from nerve involvement associated with thoracic outlet compression.
P Paraclavicular Surgical Approach
A surgical approach combining supraclavicular and infraclavicular incisions to provide extensive exposure of the thoracic outlet and subclavian vein for decompression and vascular reconstruction.
P Patch Angioplasty
A vascular reconstructive procedure in which a patch is sewn into the wall of a narrowed vein to enlarge its diameter and improve blood flow.
P Percutaneous Transluminal Angioplasty (PTA)
A catheter-based procedure using balloon inflation to widen a narrowed blood vessel. PTA may be used after thoracic outlet decompression when residual subclavian vein narrowing persists.
P Physical Therapy
A rehabilitation program involving exercises, manual therapy, posture correction, and movement retraining to improve shoulder biomechanics and reduce recurrent venous compression.
P Post-Thrombotic Syndrome
A chronic condition resulting from previous deep vein thrombosis, characterized by persistent swelling, discomfort, venous insufficiency, and impaired upper-extremity function. Prevention of post-thrombotic syndrome is a major treatment goal.
P Postural Correction
Correction of abnormal posture to reduce shoulder depression, improve thoracic outlet dimensions, and restore normal venous blood flow.
P Pregnancy
A physiological state associated with increased blood clotting tendency because of normal hormonal and coagulation changes. Pregnancy modestly increases the risk of thrombosis.
P Primary Upper-Extremity Deep Vein Thrombosis (Primary UEDVT)
A spontaneous deep vein thrombosis of the upper extremity occurring without an indwelling catheter, most commonly representing Paget-Schroetter syndrome.
P Pulmonary Embolism (PE)
A potentially life-threatening complication in which a blood clot travels from the subclavian vein through the heart into the pulmonary arteries, obstructing blood flow to the lungs.
P Pulmonary Infarction
Death of lung tissue caused by pulmonary embolism obstructing pulmonary arterial circulation.
R Range-of-Motion Exercises
Exercises designed to restore normal mobility of the shoulder and upper extremity following surgery for Paget-Schroetter syndrome. Early range-of-motion exercises help prevent stiffness and preserve function.
R Recurrent Blood Clot
A new thrombus that develops after successful clot dissolution or treatment. Preventing recurrent clot formation is a primary goal of long-term management.
R Recurrent Thrombosis
Formation of another thrombus after initial treatment. The chapter notes that recurrent thrombosis remains common despite thrombolysis and anticoagulation therapy.
R Residual Subclavian Vein Stenosis
Persistent narrowing of the subclavian vein following thrombolysis or thoracic outlet decompression surgery. Residual stenosis may require vascular reconstruction or balloon angioplasty.
R Respiratory Distress
Difficulty breathing resulting from pulmonary embolism or pulmonary infarction. Respiratory distress is a medical emergency requiring immediate treatment.
R Restenosis
Recurrent narrowing of a blood vessel after balloon angioplasty or vascular intervention. The chapter identifies restenosis as a major limitation of endovascular treatment.
R Reteplase
A fibrinolytic medication used during catheter-directed thrombolysis to dissolve blood clots within the venous system.
S Scalenectomy
Surgical removal of one or more scalene muscles to enlarge the thoracic outlet and reduce subclavian vein compression.
S Scapular Biomechanics
The coordinated movement of the scapula during upper-extremity motion. Restoration of normal scapular biomechanics is emphasized as an important component of conservative treatment.
S Scapular Stabilization Exercises
Exercises designed to improve scapular control, shoulder mechanics, and posture to reduce thoracic outlet compression.
S Scar Tissue
Dense fibrous connective tissue formed following chronic injury or inflammation. Scar tissue narrows the subclavian vein and contributes to recurrent venous obstruction.
S Shoulder Biomechanics
The coordinated interaction of the clavicle, scapula, ribs, muscles, and joints during shoulder movement. Abnormal biomechanics contribute to venous thoracic outlet syndrome.
S Shoulder Girdle
The clavicle, scapula, and associated musculature supporting the upper extremity. Downward displacement of the shoulder girdle contributes to narrowing of the thoracic outlet.
S Soft Tissue Therapy
Hands-on treatment of muscles and fascia surrounding the thoracic outlet to reduce external compression of the subclavian vein.
S Sports Overuse Injury
An injury resulting from repetitive athletic activity without adequate recovery. Sports overuse injuries are among the leading causes of Paget-Schroetter syndrome.
S Sternoclavicular Joint
The joint connecting the clavicle to the sternum. Restoration of sternoclavicular joint mobility may improve shoulder mechanics and reduce thoracic outlet compression.
S Stent Fracture
Breakage of a vascular stent following implantation. The chapter identifies stent fracture as one reason venous stenting has fallen out of favor for treating Paget-Schroetter syndrome.
S Subclavian Vein
The principal vein draining the upper extremity. Chronic compression of the subclavian vein is the primary pathological event leading to venous thoracic outlet syndrome and Paget-Schroetter syndrome.
S Subclavian Vein Patch Angioplasty
A reconstructive vascular procedure in which a patch is sewn into the wall of the subclavian vein to enlarge its diameter and restore venous blood flow.
S Subclavian Vein Stenosis
Narrowing of the subclavian vein caused by fibrosis, scar tissue, or chronic external compression.
S Subclavius Muscle
A muscle beneath the clavicle that contributes to narrowing of the costoclavicular space and compression of the subclavian vein.
S Supraclavicular Approach
A surgical approach above the clavicle commonly used to decompress the thoracic outlet and treat neurogenic or arterial thoracic outlet syndrome.
S Swimmer's Thrombosis
An informal term sometimes used to describe Paget-Schroetter syndrome because of its association with repetitive overhead swimming motions.
T Tachycardia
An abnormally rapid heart rate. Tachycardia is one of the warning signs of pulmonary embolism.
T Thoracic Outlet Decompression
A surgical procedure intended to enlarge the thoracic outlet by removing structures compressing the subclavian vein.
T Thoracic Outlet Syndrome (TOS)
A disorder caused by compression of the neurovascular structures passing through the thoracic outlet. Chapter 12 focuses specifically on its venous complications, particularly Paget-Schroetter syndrome.
T Thoracic Spine
The portion of the spine corresponding to the rib cage. Thoracic spine mobility influences shoulder mechanics and is addressed during conservative treatment.
T Thrombolysis
Medical dissolution of a blood clot using clot-dissolving medications. Catheter-directed thrombolysis is considered the standard acute treatment for Paget-Schroetter syndrome.
T Thrombolytic Therapy
Treatment with medications that dissolve blood clots and restore blood flow through an occluded vein.
T Thrombophilia
An inherited or acquired tendency toward excessive blood clot formation. Although thrombophilia is discussed, Paget-Schroetter syndrome is presented primarily as a mechanical compression disorder.
T Thrombus
A blood clot formed within a blood vessel. A thrombus within the subclavian vein is the defining feature of Paget-Schroetter syndrome.
T Tissue Ischemia
Insufficient oxygen delivery to tissues because of impaired blood flow. Prolonged ischemia may result in tissue necrosis.
T Tissue Necrosis
Death of body tissue caused by prolonged oxygen deprivation resulting from severe vascular obstruction.
T Transluminal Angioplasty
See Percutaneous Transluminal Angioplasty (PTA). A catheter-based procedure used to widen narrowed veins following thrombolysis or surgery.
U Upper-Extremity Deep Vein Thrombosis (UEDVT)
Deep vein thrombosis involving the subclavian or axillary veins. Paget-Schroetter syndrome is the classic example of primary UEDVT caused by thoracic outlet compression.
U Urschel's Sign
Prominent superficial collateral veins visible over the shoulder or upper chest, indicating chronic obstruction of the subclavian vein.
V Vascular Reconstruction
Surgical repair or rebuilding of damaged veins to restore normal venous blood flow after decompression.
V Vascular Thoracic Outlet Syndrome
Thoracic outlet syndrome involving compression of the subclavian artery or subclavian vein. Paget-Schroetter syndrome represents the venous form of vascular thoracic outlet syndrome.
V Venography
A contrast imaging study of the venous system used to identify subclavian vein obstruction, collateral circulation, and positional compression.
V Venoplasty
A catheter-based procedure used to widen narrowed veins. The chapter notes its limited long-term success for chronic subclavian vein compression.
V Venous Congestion
Pooling of blood caused by impaired venous drainage from the upper extremity. Venous congestion produces swelling, heaviness, discoloration, and discomfort.
V Venous Hypertension
Elevated venous pressure caused by obstruction of venous outflow. Persistent venous hypertension may influence treatment decisions.
V Venous Stasis
Slowing or stagnation of venous blood flow, promoting thrombus formation within the subclavian vein.
V Venous Stenting
Placement of a metal stent within the subclavian vein to maintain vessel patency. The chapter concludes that long-term effectiveness remains questionable because of external compression and stent fracture.
V Venous Thoracic Outlet Syndrome (VTOS)
Compression of the subclavian vein within the thoracic outlet, producing impaired venous drainage and, in severe cases, Paget-Schroetter syndrome.
V Venous Thrombosis
Formation of a blood clot within a vein. Venous thrombosis of the subclavian vein defines Paget-Schroetter syndrome.
V Venous Bypass Graft
A surgically created bypass around a damaged or obstructed venous segment to restore blood flow.
W Warfarin
An oral anticoagulant commonly prescribed following thrombolysis or surgery to reduce recurrent thrombosis.
W Wrestling
An overhead and upper-extremity intensive sport recognized as a risk factor for developing Paget-Schroetter syndrome because of repetitive shoulder loading. No major glossary terms beginning with X appear in Chapter 12. No major glossary terms beginning with Y appear in Chapter 12. No major glossary terms beginning with Z appear in Chapter 12.
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