This document discusses Paget-Schroetter syndrome, also known as effort thrombosis, which is thrombosis (blood clot) of the axillary and subclavian veins caused by repetitive arm motions. It affects young, active individuals and causes swelling and pain in the arm. Treatment options discussed include anticoagulation alone versus thrombolysis or decompression of the thoracic outlet through surgery. Follow up of surgical patients found low complication rates, satisfactory long-term outcomes with patent veins, and good post-operative quality of life scores.

2. Image from http://www.nlm.nih.gov/medlineplus/ency/imagepages/8963.htm INTRODUCTION

3. I mage from http://www.nlm.nih.gov/medlineplus/ency/imagepages/8963.htm Anterior scalene muscle Subclavius muscle PATHOPHYSIOLOGY

4. PATHOPHYSIOLOGY Anterior scalene muscle Subclavius muscle Pinch of the vein in arm abduction

5. 2 / 100.000 per year 1-4% of all DVT INCIDENCE Lindblad B et al. DVT of the axillary-subclavian veins: epidemiologic data, treatment and late sequelae. Eur J Vasc Surg 1988; 2:161-5

6. Mean age early 30s Male to Female ratio 2:1 Right Arm (dominant) 80% Vigorous exercise 60-80% EPIDEMIOLOGY Illig KA and Doyle AJ. A comprehensive review of Paget-Schroetter syndrome. J Vasc Surg 2010;51:1538-47

7. Blue, swollen, painful upper extremity Edema + dilated superficial veins in arm, neck, chest Pulmonary embolism 6-15% NATURAL HISTORY: CLINICAL PRESENTATION Adams JT and DeWeese JA. Effort thrombosis of the axillary and subclavian veins. J Trauma 1971;11:923-30

11. Anticoagulation alone Thrombolytic therapy Decompression of thoracic outlet TREATMENT: CONTROVERSIES

12. 2000-2011 22 patients 14 women / 9 men Medium age 32 years Onset of symptoms 3,2 days (SD 7,2) Sports/Risk profession 72,7% TREATMENT

17. Pneumothorax 4,3% Horner 4,3% COMPLICATIONS

19. FOLLOW UP

21. CONCLUSIONS Low complication rate Satisfactory long-term outcomes Good quality of life