Paget–Schroetter disease
The Paget- Schroetter syndrome ( synonym: arm and shoulder belt vein thrombosis), named after the English surgeon Sir James Paget and the Austrian internist Leopold Schrötter of Kristelli, is a thrombosis of the deep arm, axillary or subclavian vein. The Latin names of the vessels loud brachial vein, axillary vein and subclavian vein. That is why it is also called a brachial, axillary or Subclaviathrombose, depending on the extent of the closure. It grows mainly in young adult males and usually affects the right side. About 2 % of all thromboses are localized in the area of the arm and shoulder girdle.
Symptoms
The thrombosis usually causes no pain. Other symptoms of the disease are swelling of the arm with red to bluish discoloration, enhanced visibility of surface veins with blotchy skin ( as a sign of the formation of collateral circulation ), a feeling of pressure in the axilla and a feeling of tension. As a complication, it may, if the thrombus resolves, come to a pulmonary embolism. In this case, other symptoms such as shortness of breath and pain may occur in the area of the chest.
Cause
In a number of these patients can also be found after a thorough investigation, no cause: The thrombosis originated spontaneously. Between the clavicle and the first rib, the subclavian vein is fixed and can be easily damaged mechanically or compressed here. That's why this post is usually the starting point of thrombosis.
A common cause for the development of Paget- Schroetter syndrome is the thoracic outlet syndrome, in which there will be bottlenecks for the veins through bone ( cervical rib, clavicle fractures) or muscles. Another cause is the forced loading of the arm in question ( so-called thrombosis par effort) through sports such as tennis, weight lifting or working over your head, such as in the ceiling painting. Even while sleeping or driving a car can cause a prolonged compression of the veins, which favors formation of thrombosis. In addition, medical measures such as the placement of a central venous catheter to irritation in the vessel wall and lead to thrombosis. In particular, an elderly patient should be considered in an increased tendency to thrombosis in the context of a previously unknown cancer suffering.
Diagnostics
Ultrasonography with color Doppler has become the method of choice for diagnosis. As older method is the Armvenenphlebografie available. This contrast agent is injected through an arm vein and observed the flow in the veins to the heart under fluoroscopy and documented as X-ray image.
Treatment
Drug therapy
For non- spontaneous resolution of thrombosis should be treated with medication. This primarily includes the taking of anticoagulants or in severe cases Lysemitteln. Most will be treated for several weeks with heparins or ' oral anticoagulants ' ( coumarins ). In rare applied thrombolysis is a risk of cerebral hemorrhage. Another treatment option offers the local dissolution of the clot through a catheter inserted into the vein, which may come to embolism, however.
Surgical treatment
If the compression has a tangible cause, is indicated surgical treatment. For example, a distance of cervical ribs or exostosis of the first rib done, a mobilization of the subclavian muscle or a Desinsertion of musculus scalenus anterior and posterior.
Course
Overall, the shape of the arm and shoulder girdle vein thrombosis is usually pretty inexpensive. It comes after a few weeks, usually to a reopening of the vessel. The swelling of the arm can tilt back soon after. The risk of pulmonary embolism is present, but significantly less than in the leg and pelvic vein thrombosis:
- Subclaviathrombose pulmonary embolism rate of about 3%
- Vein thrombosis pulmonary embolism rate of about 10-15%