Paget-Schroetter Syndrome

Paget-Schroetter syndrome or effort thrombosis is a venous thoracic outlet syndrome involving the subclavian vein and the compression leads to thrombosis of the vein. The subclavian vein is highly vulnerable to injury as it passes under the first rib at the anterior part of the thoracic outlet. In addition to extrinsic compression, repetitive forces frequently lead to intrinsic damage and scar tissue formation. This disease is underestimated and involves mainly young persons. Once diagnosed, different approaches can be taken. Catheter-directed thrombolytic therapy is usually successful if initiated within 10–14 days of clot formation or anticoagulation can be another treatment possibility. Most surgeons believe decompression of the thoracic venous outlet, usually through first rib excision, partial anterior scalenectomy, resection of the costoclavicular ligament, and thorough external venolysis, is necessary as well. This chapter will cover etiology, medical and surgical treatment, and postoperative care of patients affected by and treated for this disease.