Axillo-Subclavian Vein Thrombosis

Overview

What is axillo-subclavian vein thrombosis?

Axillo-subclavian vein thrombosis, also called Paget-Schroetter Syndrome, is a rare medical condition in the general population. But, it is the one of the most common vascular conditions to affect young, competitive athletes. The condition develops when a vein in the armpit (the axilla) or in the front of the shoulder (the subclavian vein) is compressed by the collarbone (clavicle), the first rib, or the surrounding muscle. It is considered a type of thoracic outlet syndrome.

As the person uses his or her arm repeatedly and the axillo-subclavian vein is compressed, the vein becomes inflamed. Over time, fibrous tissue builds up in the vein. The inside of the vein eventually becomes too narrow to allow normal blood flow. As a result, a blood clot forms.

As the person uses his or her arm repeatedly and the axillo-subclavian vein is compressed, the vein becomes inflamed. Over time, fibrous tissue builds up in the vein. The inside of the vein eventually becomes too narrow to allow normal blood flow. As a result, a blood clot forms.

Symptoms and Causes

What are the symptoms of axillo-subclavian vein thrombosis?

Patients with axillo-subclavian vein thrombosis can have the following symptoms in the affected arm and hand:

  • Sudden swelling
  • Bluish skin color
  • Heaviness and pain

With time, the condition can also cause the neck, face and area around the eyes to become swollen and puffy, and the face may be slightly blue on the affected side.

Diagnosis and Tests

How is axillo-subclavian vein thrombosis diagnosed?

Your doctor will likely use a series of imaging studies to locate the blood clot in your vein. You will not need all of these tests, but you may have more than one. These studies include:

  • Duplex ultrasound
  • Catheter-directed contrast venography
  • CTA (computerized tomography arteriography)
  • MRA (magnetic resonance arteriography)

In addition, a vascular specialist may order blood tests to see if a genetic condition is responsible for the axillo-subclavian vein thrombosis. Some genetic conditions that make the blood more prone to clotting (hypercoagulable syndromes), including factor V Leiden mutation, Lupus anti-coagulant, and others can lead to axillo-subclavian vein thrombosis. Your doctor will order blood tests to measure the amount of time it takes for your blood to clot.

Management and Treatment

What problems are associated with an untreated axillo-subclavian vein thrombosis?

Risks associated with an axillo-subclavian vein thrombosis that is not treated include:

  • Pulmonary embolism – occurs in 20% to 30% of patients
  • Recurrent thrombosis
  • Post-thrombotic syndrome with persistent pain and swelling in the arm
  • Stroke
  • Chronic venous insufficiency
  • Pulmonary hypertension
  • Right-sided heart failure
  • In very rare cases, the affected arm may need to be amputated

What is the treatment for patients with axillo-subclavian vein thrombosis?

Medical management

Most young adults with axillo-subclavian vein thrombosis go to the doctor within the first two weeks symptoms begin. In this relatively early stage of the condition, medications to dissolve clots (thrombolytics) are usually successful. The medication is delivered through a catheter inserted into the vein. When there is a single blood clot that the doctor can see clearly during imaging tests, the vascular specialist may use a technique called mechanical thrombectomy to break up the clot or suction thrombectomy to remove the clot. Thrombectomy is usually used along with thrombolytic medications.

After the clot is broken up or removed (thrombolysis), treatment continues with blood thinners. Patients begin with heparin and then take warfarin (coumadin) for an extended period of time to help prevent another clot from forming.

Your doctor will also likely have you:

  • Use a compression sleeve on the affected arm
  • Do arm elevations
  • Avoid using your arm until symptoms are gone
  • Participate in physical therapy

Surgery

Most patients should have surgical therapy for axillo-subclavian vein thrombosis unless they have a clotting abnormality of the blood.

In many cases, axillo-subclavian vein thrombosis is caused by abnormally formed bones or blood vessels. If this is the case, your doctor will likely suggest surgery to:

  • Remove the rib causing the problem, as well as surrounding muscles (for patients who have thoracic outlet syndrome that is causing compression of the subclavian vein)
  • Restore blood flow through the subclavian vein (for patients who have scar tissue or blockage or another thrombosis)

How quickly will I recover from surgery?

Patients who have surgery to remove a rib usually spend one night in the hospital. They start physical therapy in the first week after surgery. Within a month, most patients are back to normal and may even be able to do more than before surgery.

How effective is treatment for patients with axillo-subclavian vein thrombosis?

If you receive prompt treatment for the condition, you can expect to make a full recovery.

What type of follow-up care will I need?

It is important to continue your care with a vascular specialist to insure that you do not develop another blood clot. Your doctor will tell you how often you should be seen.

Resources

Doctors Who Treat

Doctors vary in quality due to differences in training and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.

Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart, Vascular & Thoracic Institute Outcomes.

Cleveland Clinic Heart, Vascular & Thoracic Institute Vascular Medicine Specialists and Surgeons

Choosing a doctor to treat your vascular disease depends on where you are in your diagnosis and treatment. The following Heart, Vascular & Thoracic Institute Sections and Departments treat patients with all types of vascular disease, including blood clotting disorders:

Section of Vascular Medicine: for evaluation, medical management or interventional procedures to treat vascular disease. In addition, the Non-Invasive Laboratory includes state-of-the art computerized imaging equipment to assist in diagnosing vascular disease, without added discomfort to the patient. Call Vascular Medicine Appointments, toll-free 800-223-2273, extension 44420 or request an appointment online.

Department of Vascular Surgery: surgery evaluation for surgical treatment of vascular disease, including aorta, peripheral artery, and venous disease. Call Vascular Surgery Appointments, toll-free 800-223-2273, extension 44508 or request an appointment online.

You may also use our MyConsult second opinion consultation using the Internet.

The Heart, Vascular & Thoracic Institute also has specialized centers and clinics to treat certain populations of patients:

Learn more about experts who specialize in the diagnosis and treatment of vascular and arterial disease.

See About Us to learn more about the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute.

Contact

If you need more information, click here to contact us, chat online with a nurse or call the Miller FamilyHeart, Vascular & Thoracic Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.

Becoming a Patient

Treatment Options

Additional information about vascular treatment options can be found at:

Treatment Guides

Diagnostic Tests

Diagnostic tests are used to diagnose coronary artery disease and the most effective treatment method.

Webchats

Our webchats and video chats give patients and visitors another opportunity to ask questions and interact with our physicians.

Videos

Interactive Tools

Additional information and resources

*A new browser window will open with this link. The inclusion of links to other websites does not imply any endorsement of the material on those websites nor any association with their operators.

Why choose Cleveland Clinic for your care?

Our outcomes speak for themselves. Please review our facts and figures and if you have any questions don't hesitate to ask.

Last reviewed by a Cleveland Clinic medical professional on 04/25/2019.

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy