Paget-Schroetter disease overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Historical Perspective
Spontaneous axillary-subclavian vein thrombosis (ASVT) has been first described by Cruveilhier. Sir James Paget identified the subclavian vein thrombosis in one of his patients. Hughes created the term "Paget-Schroetter".
Classification
There is no established system for the classification of Paget-Schroetter disease.
Pathophysiology
It is thought that Paget-Schroetter disease is a form of axillary-subclavian vein thrombosis resulted from compression of aforementioned veins. This condition is more common in athletes and/or manual labors. Some studies link Paget-Schroetter disease with anatomical defects involving the thoracic outlet.
Causes
Common causes of Paget-Schroetter disease include a repetitious activity of upper extremity, hypertrophied scalenus anterior muscle, presence of osseous exostosis, congenital deformities, and major vein catheterization.
Differentiating Paget-Schroetter disease from Other Diseases
Since early diagnosing and treatment of Paget-Schroetter disease is crucial to halt fatal complications like pulmonary embolism, it is important to differentiate it from other diseases with similar presentations and findings.
Epidemiology and Demographics
Paget-Schroetter disease usually affects young individuals. The incidence of Paget-Schroetter disease is roughly 2.03 per 100,000 people per year.Men are more commonly affected by Paget-Schroetter disease than women.
Risk Factors
Common risk factors in the development of Paget-Schroetter include repetitive upper extremity, overdeveloped anterior scalene muscle, congenital bands between the first and second rib and thoracic outlet syndrome.
Screening
Natural History, Complications, and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Interventions
Surgery
Based on pathophysiology of the Paget-Schroetter disease, extrinsic compression and endothelial damage to the vein are among the underlying problems that should be addressed. While thrombolysis only treats acute symptoms, correction surgery decreases recurrence in patients with suspected subclavian vein entrapment. Correction surgery involves both thoracic outlet decompression and restoration of vein patency.
Primary Prevention
There are no established measures for the primary prevention of Paget-Schroetter disease.
Secondary Prevention
There are no established measures for the secondary prevention of Paget-Schroetter disease.