Paget-Schroetter, syndrome

Result of upper limb venous compression caused by a narrow thoracic inlet caused by a cervical rib, an enlarged anterior scalene muscle or a thick costoclavicular ligament. The compression is often positional (favoured by prolonged or repetitive abduction of the shoulder) and is revealed in general by subclavian vein thrombosis with edema (84%), pain (58%) and cyanosis (58%) of the affected limb. Neurological signs (paresthesias, motor weakness) are present in 1/3 of cases. Post thrombotic syndrome may develop if the thrombosis persists or relapses.

Although anatomical factors are generally present from childhood, this disease almost never appears during the first 10 years of life. At risk activities are swimming, playing baseball, the practice of weight lifting, from which the name of 'Thrombosis due to the effort'.

Treatment: keep that diagnosis in mind ! Thrombolysis with or without endovascular thrombectomy and/or dilatation, and, if necessary, corrective surgery of the anatomical cause, 4-6 weeks later.

Check the absence of thrombophilia especially if there is a personal or familial history  of thrombosis.


Anesthetic implications:

check hemostasis (often preoperative anticoagulation); avoid placing an IV line in a limb with a post thrombotic syndrome; if possible, avoid a central venous access (subclavian or PICC line) in a limb that has been affected by this syndrome


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Updated: November 2018