Paget-Schrötter syndrome
Content:
- Symptoms of Paget-Schrötter Syndrome
- Causes of Paget-Schrötter syndrome
- Treatment of Paget-Schrötter syndrome
Paget-Schrötter syndrome is an acute thrombosis that affects the subclavian or axillary vein.
According to the available statistics, the disease is 2 times more likely to occur on the right hand than on the left. Among patients with this syndrome, there are more males than females. Moreover, all men are predominantly young. The manifestation of the syndrome is rarely spontaneous; certain factors are required for its onset. Effort syndrome - this is sometimes called this thrombosis in medical practice.
Symptoms of Paget-Schrötter Syndrome
The disease passes through two stages of development: acute (in mild, moderate and severe form, the severity is determined by the level of venous pressure) and chronic.
The symptoms of Paget-Schroetter syndrome are as follows:
- In the armpit, or in the area of the collarbone, severe pain occurs. It is unexpected for a person, as it appears suddenly. The nature of the pain is dull, bursting. Sometimes, a migratory burning sensation may occur in various places of the shoulder and forearm.
- There is a feeling of warmth or heat in the area of inflammation.
- In the course of the vein, redness or blue discoloration of the skin is possible.
- The edema spreads from the hand to the subclavian region and reaches a maximum 24 hours after the onset of the syndrome. As a result, the entire upper limb thickens, its muscles are in tension. As the disease progresses, the tension from the tissues of the hand subsides and the edema becomes loose. Edema may spread to the upper chest.
- The distal extremities become cyanotic.
- In the area of the armpit, near the neck from the affected side, the venous network begins to appear.
- In the cubital fossa and near the forearm, the vessels swell and dilate strongly, which indicates the inability of the collaterals to cope with the outflow of blood.
- If the thrombosis spreads to the brachial and axillary veins, then the disease becomes severe. The edema grows, blocking the pulse on the radial artery, the affected limb becomes cold, there is a risk of gangrene formation.
- As the disease regresses, the reverse development of the clinical picture is observed, although it is not always possible to achieve complete disappearance of symptoms.
If these symptoms occur, timely treatment is required, as the risk of developing pulmonary embolism increases.
Causes of Paget-Schrötter syndrome
The causes of Paget-Schrötter syndrome are various, among them:
- A predisposition to the formation of the syndrome is present in people with a high standing of the first rib. The risk of thrombus formation increases with hypertrophy of the subclavian muscle and tendon part of the pectoralis minor.
- Playing sports, or heavy physical labor, often lead to compression of the subclavian muscle as a result of pronounced strains of the muscles of the shoulder girdle in combination with the movements of the shoulder joint. The muscle is clamped by the clavicle and the first rib.
- Lifting weights is a risk factor.
- Posture disorders increase the risk of deep subclavian vein thrombosis.
- Bone pathologies (proliferation of the cervical vertebrae, the presence of an additional cervical rib) have a negative effect.
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Factors provocateurs are the suffered fractures of the clavicle, especially those that are accompanied by the appearance of callus.
- The position of the hand during sleep matters. The posture in which the person's head lies on the shoulder has a negative effect.
So, essential for the development of Paget-Schroetter syndrome is:
- Severe physical activity on the vein;
- Her long-term systematic trauma.
Treatment of Paget-Schrötter syndrome
Treatment of Paget-Schroetter syndrome in the vast majority of cases is conservative. The goals of therapeutic measures are: inhibition of the process of thrombus formation, fixation of a thrombus to the venous wall, relieving spasm, eliminating inflammation, normalizing microcirculation in tissues.
The patient is not shown strict bed rest, however, maximum comfort must be provided for the injured arm. It is advisable to keep it in an elevated position.
If necessary, it is possible to use anticoagulants: Heparin in combination with Fibrinolysin. The drugs are administered intravenously and subsequently intramuscularly.
Immediately after the manifestation of the syndrome, doctors prescribe flavonoids to the patient: Venoruton, Detralex, Troxevasin, Eskuzan, Glivenol. These drugs can eliminate pain and inflammation and improve metabolic processes.
To relieve spasm, improve blood flow, intravenous administration of Trental or Xanthinol is prescribed. Orally, after the elimination of the acute phase, you can take No-shpa, Galidor, Papaverin.
The indication for surgical intervention is the threat of gangrene formation, pronounced hemodynamic disturbances.
If the disease has become chronic, it is possible to perform vascular operations aimed at reconstructing the vein in order to improve venous outflow.
As for the prognosis, it is generally favorable, however, complete recovery may not occur. Severe complications such as gangrene or thromboembolism are rare.
Author of the article: Sokov Andrey Vladimirovich | Neurologist
Education: In 2005 completed an internship at the IM Sechenov First Moscow State Medical University and received a diploma in Neurology. In 2009, completed postgraduate studies in the specialty "Nervous diseases".
