scholarly journals Recurrent Upper Extremity Thrombosis Associated with Overactivity: A Case of Delayed Diagnosis of Paget-Schroetter Syndrome

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Himani Sharma ◽  
Abhinav Tiwari
Keyword(s):  
Upper Extremity ◽  
Subclavian Vein ◽  
Delayed Diagnosis ◽  
Surgical Decompression ◽  
Upper Extremities ◽  
Coagulation Cascade ◽  
First Episode ◽  
Occupational History ◽  
External Compression

Paget-Schroetter syndrome is thrombosis of the axillary-subclavian vein that is associated with strenuous and repetitive activity of the upper extremities. Overuse of the arm coupled with external compression results in microtrauma in the intima of the subclavian vein, resulting in the activation of the coagulation cascade. Diagnosis is usually made by Doppler ultrasound and the treatment involves thrombolysis, while routine surgical decompression of the thoracic outlet is controversial. In this report, we present a case of a patient who presented with a second episode of spontaneous right upper extremity deep venous thrombosis. The first episode was inadequately treated with oral anticoagulation alone. During the second episode, Paget-Schroetter syndrome was diagnosed, after careful review of his occupational history. He subsequently underwent angioplasty and decompression of thoracic outlet with no recurrence of thrombosis in a 12-month follow-up period.

scholarly journals Bilateral Upper Extremity DVT in a 43-Year-Old Man: Is It Thoracic Outlet Syndrome?!

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Hadoun Jabri ◽  
Sarbajit Mukherjee ◽  
Devang Sanghavi ◽  
Shyam Chalise
Keyword(s):  
Upper Extremity ◽  
Subclavian Vein ◽  
Thoracic Outlet Syndrome ◽  
Rare Condition ◽  
Surgical Decompression ◽  
Upper Extremities ◽  
Vein Thrombosis ◽  
First Case ◽  
Arm Swelling ◽  
Deep Vein

Recurrent deep venous thrombosis, involving bilateral upper extremities, is an extremely rare phenomenon. We are presenting a 43-year-old man who was diagnosed with left upper extremity deep vein thrombosis (UEDVT) and was treated with anticoagulation and surgical decompression in 2004. 9 years later, he presented with right arm swelling and was diagnosed with right UEDVT using US venous Doppler. Venogram showed compression of the subclavian vein by the first rib, diagnosing thoracic outlet syndrome (TOS). He was treated with anticoagulation and local venolysis and later by surgical decompression of the subclavian vein. Bilateral UEDVT, as mentioned above, is an extremely rare condition that is uncommonly caused by TOS. To our knowledge, we are reporting the first case of bilateral UEDVT due to TOS. Diagnosis usually starts with US venous Doppler to detect the thrombosis, followed by the gold standard venogram to locate the area of obstruction and lyse the thrombus if needed. The ultimate treatment for TOS remains surgical decompression of the vascular bundle at the thoracic outlet.

scholarly journals Paget-Schroetter Syndrome in a Young Female

2021 ◽  
Vol 9 ◽  
pp. 232470962110032
Author(s):  
Vikram Sangani ◽  
Mytri Pokal ◽  
Mamtha Balla ◽  
Vijay Gayam ◽  
Venu Madhav Konala
Keyword(s):  
Subclavian Vein ◽  
Outlet Obstruction ◽  
Case Series ◽  
Surgical Decompression ◽  
Coagulation Cascade ◽  
High Dose ◽  
Randomized Controlled Studies ◽  
Catheter Directed Thrombolysis ◽  
Effort Thrombosis ◽  
Arm Swelling

Paget-Schroetter syndrome or effort thrombosis is a relatively rare primary spontaneous thrombosis of upper extremity deep veins secondary to entrapment of axillary subclavian veins from an abnormality of the thoracic outlet. It is commonly seen in young adults who lift heavy weights or strenuous use of the upper extremities during athletic activities. Repetitive microtrauma to the subclavian vein secondary to narrow costoclavicular space and strenuous activities leads to intimal layer inflammation, hypertrophy, fibrosis, and coagulation cascade activation. Management of Paget-Schroetter syndrome differs from the venous thrombosis of the lower extremity as treatment includes anticoagulation, thrombolysis, and surgical decompression. Early recognition and timely management are required to prevent significant disability from post-thrombotic syndrome and long-term morbidity from recurrent thromboembolism and pulmonary embolism. Internists and emergency physicians should be aware of the disease’s presentation, treatment options, and early referral to vascular surgeons since prompt initiation of appropriate treatment will have better outcomes than delayed treatment. We discussed a case of a 31-year-old female who lifts heavyweight at work, presented with right arm swelling and pain for 2 weeks, and diagnosed with axillary subclavian vein thrombosis secondary to thoracic outlet obstruction. She received a high-dose heparin drip followed by catheter-directed thrombolysis and underwent surgical decompression of axillary subclavian vein via resection of the first rib, subclavius muscle resection, partial anterior scalenectomy, and venolysis. In our review of the literature, randomized controlled studies lack the efficacy and safety of surgical decompression. However, the results are promising based on accumulated experience from vascular surgery experts and small case series. Extensive studies are needed further to delineate the protocol for the management of Paget-Schroetter syndrome.

scholarly journals Brachial index does not reflect upper extremity functionality following surgery for vascular trauma

2014 ◽  
Vol 13 (2) ◽  
pp. 83-87
Author(s):  
Erdal Simsek ◽  
Kasim Karapinar ◽  
Ilker Ince ◽  
Ahmet Tulga Ulus
Keyword(s):  
Upper Extremity ◽  
Doppler Ultrasonography ◽  
Arterial Occlusion ◽  
Upper Extremities ◽  
Postoperative Outcomes ◽  
Post Discharge ◽  
Daily Work ◽  
Hemodynamic Status ◽  
Small Series

OBJECTIVES: Vascular injuries to the upper extremities requiring surgical repair are common after accidents. However, neither postoperative functionality nor hemodynamic status of the extremity are routinely described. We evaluated the postoperative functional and hemodynamic status of patients with vascular traumas in the upper extremities. METHODS: 26 patients who suffered penetrating vascular traumas in the upper extremities from November 2008 to December 2011 were retrospectively evaluated. Data on first approach, surgical technique employed and early postoperative outcomes were recorded. Further data on the post-discharge period, including clinical functional status of the arm, Doppler ultrasonography and brachial-brachial index were also evaluated. RESULTS: Average follow up was 33.5±10.8 months. Right (1.05±0.09) and left (1.04±0.08) brachial indexes were measured during follow up,. Doppler ultrasonography showed arterial occlusion in 4 patients (15%). Near-normal brachial-brachial indexes was observed in all four of these patients with occlusion of one of the upper extremity arteries, even though they exhibited limited arm function for daily work. CONCLUSIONS: Evaluation of the postoperative outcomes of this small series of patients with penetrating vascular traumas in the upper extremity revealed that 15% of them suffered occlusion of one artery of the upper extremity. Artery occlusion did not correlate with brachial-brachial Doppler index, probably due to rich collateral circulation, but occlusion was associated with an extremity that was dysfunctional for the purposes of daily work. The result of the brachial-brachial index does not therefore correlate with functionality.

MULTIPLE ENTRAPMENT NEUROPATHY IN THE UPPER EXTREMITY

Hand Surgery ◽  
1999 ◽  
Vol 04 (02) ◽  
pp. 137-144 ◽  
Author(s):  
I-Chen Chen ◽  
Gao-Meng Zhang ◽  
Tsu-Min Tsai
Keyword(s):  
Case Series ◽  
Surgical Decompression ◽  
Upper Extremities ◽  
Entrapment Neuropathy ◽  
Symptom Improvement ◽  
Nerve Compression Syndromes ◽  
Self Assessment ◽  
High Incidence ◽  
Return To Activity

Multiple entrapment neuropathy is compression of more than two nerves in the same extremity. In this case series, 169 patients (208 upper extremities) with this condition were identified, and 124 patients (138 upper extremities) had surgical decompression after an ineffective course of conservative treatment. There were 31 men and 93 women. Average age was 41 years (range 20–87 years). Follow-up averaged 23 months (range 12 to 60 months). Our rating system included patients' self-assessment of overall symptom improvement and return to activity and a physician assessment of strength (grip and pinch) and sensibility (recovery of two-point discrimination). A total of 92 patients (67%) achieved good to excellent results. The clinical features of multiple entrapment neuropathy in our series were presented with a variety of nerve compression syndromes and with a high incidence of regional musculotendinous syndromes. In our surgical treatment, we emphasise simultaneous release of all possible compression sites with a minimally invasive endoscopic approach to achieve better results.

4.5 Year Follow-Up after Surgical Correction of Upper Extremity Deformities in Spastic Cerebral Palsy

1999 ◽  
Vol 24 (6) ◽  
pp. 719-723 ◽  
Author(s):  
G. NYLANDER ◽  
C. CARLSTRÖM ◽  
L. ADOLFSSON
Keyword(s):  
Cerebral Palsy ◽  
Upper Extremity ◽  
Reconstructive Surgery ◽  
Assessment System ◽  
Upper Extremities ◽  
Spastic Cerebral Palsy ◽  
Functional Evaluation ◽  
Postoperative Results ◽  
Hand Evaluation

Reconstructive surgery was carried out on 27 upper extremities in 24 children with deformities due to spastic cerebral palsy. Functional evaluation of the affected extremities was made preoperatively, at 6 months and at a mean of 4.5 years postoperatively using a score added to the assessment system described by the Committee on Spastic Hand Evaluation. According to the score, dysfunction of the arm was significantly reduced 6 months after the reconstructive surgery and the improvements remained essentially unchanged at the later follow-up. The addition of a score to the original assessment system facilitated the overall assessment of postoperative results.

Clinical Experience with a New Nitinol Self-Expanding Stent in Peripheral Arteries

1996 ◽  
Vol 3 (4) ◽  
pp. 369-379 ◽  
Author(s):  
Michel Henry ◽  
Max Amor ◽  
Rafael Beyar ◽  
Isabelle Henry ◽  
Jean-Marc Porte ◽  
...  
Keyword(s):  
Long Term Results ◽  
Lesion Length ◽  
Secondary Patency ◽  
Peripheral Arteries ◽  
External Compression ◽  
Nitinol Stent ◽  
Nitinol Stents ◽  
The Mean

Purpose: To evaluate a new self-expanding nitinol coil stent in stenotic or occluded peripheral arteries. Methods: Seventy-three symptomatic patients (58 men; mean age 67 years) were treated with nitinol stents for lesions in the iliac artery (9 stenoses); superficial femoral artery (SFA) (39 stenoses, 6 occlusions); popliteal artery and tibioperoneal trunk (9 stenoses, 7 occlusions); and 3 bypass grafts. Mean diameter stenosis was 84.4% ± 9.9% (range 75% to 100%), and mean lesion length was 45 ± 23 mm (range 20 to 120 mm). Results: Eighty-eight 40-mm-long stents with diameters between 5 and 8 mm were implanted percutaneously for suboptimal dilation (n = 45); dissection (n = 21); and restenosis (n = 7). All stents but one were implanted successfully; the malpositioned stent was removed, and another stent was successfully deployed. There were 3 (4.1%) failures due to thrombosis at 24 hours. During the mean 16-month follow-up (range to 44 months), 4 restenoses (3 femoral, 1 popliteal) have occurred; 2 were treated with repeat dilation and 2 underwent bypass. Primary and secondary patency rates at 18 months were 87% and 90%, respectively, for all lesions (iliac: 100% for both; femoral: 85% and 88%; popliteal: 87% and 100%). Conclusions: This new nitinol stent seems to be safe and effective with favorable long-term results, even in distal SFA lesions and popliteal arteries. Its flexibility and resistance to external compression allow its placement in tortuous arteries and near joints.

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