Paget-Schroetter disease
Encyclopedia
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 vein
s of the arm
s. These deep vein thromboses
typically occur in the axillary vein
or subclavian vein
.
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
.
(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:
"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.
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."
first proposed the idea of venous thrombosis causing upper extremity pain and swelling, and Leopold von Schrötter later linked the clinical syndrome to thrombosis of the axillary and subclavian veins.
Vein
In the circulatory system, veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood to the heart...
s of the arm
Arm
In human anatomy, the arm is the part of the upper limb between the shoulder and the elbow joints. In other animals, the term arm can also be used for analogous structures, such as one of the paired forelimbs of a four-legged animal or the arms of cephalopods...
s. These deep vein thromboses
Deep vein thrombosis
Deep vein thrombosis is the formation of a blood clot in a deep vein. Deep vein thrombosis commonly affects the leg veins or the deep veins of the pelvis. Occasionally the veins of the arm are affected...
typically occur in the axillary vein
Axillary vein
In human anatomy, the axillary vein is a large blood vessel that conveys blood from the lateral aspect of the thorax, axilla and upper limb toward the heart...
or subclavian vein
Subclavian vein
The subclavian veins are two large veins, one on either side of the body. Their diameter is approximately that of the smallest finger.-Path:Each subclavian vein is a continuation of the axillary vein and runs from the outer border of the first rib to the medial border of anterior scalene muscle...
.
Signs and symptoms
The condition is relatively rare. 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 as it has been reported to occur after vigorous activity, though it can also occur spontaneously. It may develop as a sequelea of thoracic outlet syndromeThoracic outlet syndrome
Thoracic outlet syndrome is a syndrome involving compression at the superior thoracic outlet involving compression of a neurovascular bundle passing between the anterior scalene and middle scalene...
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
Pulmonary embolism
Pulmonary embolism is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream . Usually this is due to embolism of a thrombus from the deep veins in the legs, a process termed venous thromboembolism...
.
Treatment
The traditional treatment for thrombosis is the same as for a lower extremity deep vein thrombosis, and involves anticoagulation with heparinHeparin
Heparin , also known as unfractionated heparin, a highly sulfated glycosaminoglycan, is widely used as an injectable anticoagulant, and has the highest negative charge density of any known biological molecule...
(generally low molecular weight heparin
Low molecular weight heparin
In medicine, low-molecular-weight heparin is a class of medication used as an anticoagulant in diseases that feature thrombosis, as well as for prophylaxis in situations that lead to a high risk of thrombosis....
) with a transition to warfarin
Warfarin
Warfarin is an anticoagulant. It is most likely to be the drug popularly referred to as a "blood thinner," yet this is a misnomer, since it does not affect the thickness or viscosity of blood...
.
However, J. Ernesto Molina, MD, a vascular surgeon at the University of Minnesota, has expressed the following opinion:
"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.
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."
History
The condition is named after two men. James PagetJames Paget
Sir James Paget, 1st Baronet was a British surgeon and pathologist who is best remembered for Paget's disease and who is considered, together with Rudolf Virchow, as one of the founders of scientific medical pathology. His famous works included Lectures on Tumours and Lectures on Surgical Pathology...
first proposed the idea of venous thrombosis causing upper extremity pain and swelling, and Leopold von Schrötter later linked the clinical syndrome to thrombosis of the axillary and subclavian veins.
Society and culture
Notable people who have recently been diagnosed with Paget-Schroetter disease are:- Matt PelechMatt PelechMatt Pelech is a Canadian professional ice hockey defenceman currently playing with the San Jose Sharks of the NHL. He is a draft pick of the Calgary Flames, selected in the first round, 26th overall in the 2005 NHL Entry Draft...
, Canadian ice hockey player, 2005 Calgary FlamesCalgary FlamesThe Calgary Flames are a professional ice hockey team based in Calgary, Alberta, Canada. They are members of the Northwest Division of the Western Conference of the National Hockey League . The club is the third major-professional ice hockey team to represent the city of Calgary, following the...
first-round draft pick - Isaac HansonIsaac HansonIsaac Hanson is an American musician best known as a member of the pop rock trio Hanson, which includes his two younger brothers Taylor and Zac...
, American pop rock guitarist and singer for HansonHanson (band)Hanson are an American pop rock band formed in Tulsa, Oklahoma, by brothers Isaac , Taylor , and Zac Hanson . They are best known for the 1997 hit song "MMMBop" from their major label debut album Middle of Nowhere, which earned three Grammy nominations... - Charlie Randall, American Ultimate Frisbee player, University of Wisconsin - Eau Claire EauZone
- Jacob Lien, American Ultimate Frisbee player, University of Arizona Sunburn
External links
- Overview at Uniformed Services University of the Health SciencesUniformed Services University of the Health SciencesThe Uniformed Services University of the Health Sciences is a health science university run by the U.S. federal government. The primary mission of the school is to prepare graduates for service to the U.S. at home and abroad in the medical corps....