School of Medicine and Health Sciences Poster Presentations

Title

Paget-Schroetter Syndrome in Pregnancy: Unique Considerations and Management

Document Type

Poster

Status

Medical Student

Abstract Category

Clinical Specialties

Keywords

vascular surgery, pregnancy, interventions, thoracic outlet syndrome, anticoagulation

Publication Date

Spring 2019

Abstract

Introduction: Thoracic outlet syndrome (TOS) refers to a set of symptoms caused by the compression of either the subclavian vein, artery, or brachial plexus. Venous TOS is characterized by thrombosis of the deep veins of the upper extremity including the subclavian to radial veins. Paget-Schroetter Syndrome (PSS), also known as effort-induced thrombosis, is a rare form of primary venous thoracic outlet syndrome whereby spontaneous thrombosis of the subclavian vein is instigated by repeated, vigorous overhand activity.

Case Report: A 35-year-old G1P0 Caucasian woman, a competitive swimmer by profession with no significant medical history presented to an outside facility at 8 weeks gestation by LMP with a two-day history of acute onset left upper extremity paresthesia, discoloration and swelling after swimming for 90 minutes. She was subsequently diagnosed with deep venous thrombosis (DVT) after a left upper extremity ultrasound revealed a thrombus extending from the left subclavian to the brachial vein. After overnight anticoagulation, pharmaco-mechanical thrombectomy was performed which achieved adequate outflow. First rib resection via an infraclavicular approach was then performed a week after initial presentation. Repeat venogram and pharmaco-mechanical thrombectomy was performed with balloon venoplasty yielding satisfactory result. The patient recovered without complications. On follow-up appointment 2 weeks post-operatively, arm swelling was noted to have markedly improved down to baseline and the patient had no other complaints.

Discussion: We present successful treatment of a challenging case of PSS in a pregnant patient with focus on the unique diagnostic evaluation and management of pregnant patients with PSS. Pregnancy poses unique clinical considerations when deciding the type of anticoagulation, pre and post-operative surgical care, and fetal assessment. Additionally, our case highlights the value of careful management of anticoagulation and the utility of surgical thoracic outlet decompression shortly after pharmacomechanical thrombectomy for long-term venous patency and the role of multi-disciplinary patient care with other specialties such as Hematology and Obstetrics for additional recommendations to ensure safe, long-term anticoagulation throughout pregnancy.

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Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Open Access

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Presented at Research Days 2019.

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Paget-Schroetter Syndrome in Pregnancy: Unique Considerations and Management

Introduction: Thoracic outlet syndrome (TOS) refers to a set of symptoms caused by the compression of either the subclavian vein, artery, or brachial plexus. Venous TOS is characterized by thrombosis of the deep veins of the upper extremity including the subclavian to radial veins. Paget-Schroetter Syndrome (PSS), also known as effort-induced thrombosis, is a rare form of primary venous thoracic outlet syndrome whereby spontaneous thrombosis of the subclavian vein is instigated by repeated, vigorous overhand activity.

Case Report: A 35-year-old G1P0 Caucasian woman, a competitive swimmer by profession with no significant medical history presented to an outside facility at 8 weeks gestation by LMP with a two-day history of acute onset left upper extremity paresthesia, discoloration and swelling after swimming for 90 minutes. She was subsequently diagnosed with deep venous thrombosis (DVT) after a left upper extremity ultrasound revealed a thrombus extending from the left subclavian to the brachial vein. After overnight anticoagulation, pharmaco-mechanical thrombectomy was performed which achieved adequate outflow. First rib resection via an infraclavicular approach was then performed a week after initial presentation. Repeat venogram and pharmaco-mechanical thrombectomy was performed with balloon venoplasty yielding satisfactory result. The patient recovered without complications. On follow-up appointment 2 weeks post-operatively, arm swelling was noted to have markedly improved down to baseline and the patient had no other complaints.

Discussion: We present successful treatment of a challenging case of PSS in a pregnant patient with focus on the unique diagnostic evaluation and management of pregnant patients with PSS. Pregnancy poses unique clinical considerations when deciding the type of anticoagulation, pre and post-operative surgical care, and fetal assessment. Additionally, our case highlights the value of careful management of anticoagulation and the utility of surgical thoracic outlet decompression shortly after pharmacomechanical thrombectomy for long-term venous patency and the role of multi-disciplinary patient care with other specialties such as Hematology and Obstetrics for additional recommendations to ensure safe, long-term anticoagulation throughout pregnancy.