Paget-Schroetter disease
| Paget-Schrotter disease | |
|---|---|
| Classification and external resources | |
 Anterior view of right upper limb and thorax |
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| ICD-10 | I82.8 |
| ICD-9 | 453.8 |
| DiseasesDB | 34349 |
| eMedicine | med/2772 |
Paget-Schroetter disease, also known as Paget-von Schrötter disease or upper extremity deep vein thrombosis (UEDVT) is a medical condition in which blood clots form in the deep veins of the arms. These deep vein thromboses typically occur in the axillary vein or subclavian vein.
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[edit] Signs and symptoms
The condition is relatively rare.[1] It usually presents in young and otherwise healthy patients, also is more often in males than females. The syndrome also became known as “effort-induced thrombosis” in the 1960s[2] as it has been reported to occur after vigorous activity,[3] though it can also occur spontaneously. It may develop as a sequelea of thoracic outlet syndrome
Symptoms may include sudden onset of pain, warmth, redness, blueness and swelling in the arm. These DVT's should be treated as an emergency, but rarely cause fatal pulmonary embolism.
[edit] Treatment
The traditional treatment for thrombosis is the same as for a lower extremity deep vein thrombosis, and involves anticoagulation with heparin (generally low molecular weight heparin) with a transition to warfarin.
However, J. Ernesto Molina, MD, a vascular surgeon at the University of Minnesota, has expressed the following opinion:[4][unbalanced opinion][dated info]
"The current acceptable treatment for that condition is lytic therapy followed by surgery. The patients were followed up to investigate the rate of recurrence. However, if surgery is not done, the problem will invariably recur.[5][6][7] If patients are treated with only anticoagulants and even thrombolytics but no surgery, I expect the recurrence rate to be high." Because "most of the patients who suffer this condition do not have any abnormality in their coagulation mechanism" and in fact suffer from "a direct injury to the endothelium," the "treatment for Paget-Schroetter syndrome ... entails the use of thrombolytics followed by surgery to decompress the thoracic inlet and widening of the vein, usually with a vein patch."
[edit] History
The condition is named after two men. James Paget[5] first proposed the idea of venous thrombosis causing upper extremity pain and swelling,[6] and Leopold von Schrötter later linked the clinical syndrome to thrombosis of the axillary and subclavian veins.[7]
[edit] See also
- Thoracic outlet syndrome, a possible cause of blood clots in arms
[edit] References
- ^ Hughes, ES (1949). "Venous obstruction in the upper extremity; Paget-Schroetter's syndrome; a review of 320 cases". Surg Gynecol Obstet 88 (88): 89–127. PMID 18108679.
- ^ Drapanas, T; Curran, WL (1966). "Thrombectomy in the treatment of "effort" thrombosis of the axillary and subclavian veins". Journal of Trauma (6): 107.
- ^ Flinterman LE; Van Der Meer FJ; Rosendaal FR; Doggen CJ (Aug 2008). "Current perspective of venous thrombosis in the upper extremity". Journal of Thrombosis and Haemostasis 6 (8): 1262–6. doi:10.1111/j.1538-7836.2008.03017.x. PMID 18485082.
- ^ Molina JE (March 2005). "Letter regarding article by Martinelli et al., "Risk factors and recurrence rate of primary deep vein thrombosis of the upper extremities"". Circulation 111 (9): e118; author reply e118. doi:10.1161/01.CIR.0000153853.50893.61. PMID 15753222. http://www.circ.ahajournals.org/cgi/content/full/111/9/e118#R2-160023.
- ^ a b Paget-von Schrötter disease at Who Named It?
- ^ a b Paget J (1866). "On gouty and some other forms of phlebitis". St. Bartholomew's Hospital Reports 2: 82–92.
- ^ a b L. von Schrötter. Erkrankungen der Gefässe. Nothnagel’s Handbuch der speciellen Pathologie und Therapie, 1901. Volume XV, II. Theil, II. Hälfte: Erkrankungen der Venen. Wien, Hölder, 1899: 533–535.
[edit] External links
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