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Paget-Schroetter Syndrome is a thrombosis in the acute stage, affecting the subclavian or axillary vein.
According to available statistics, the disease occurs 2 times more often on the right hand than on the left. There are more males than females among patients with this syndrome. Moreover, all men are predominantly young. The manifestation of the syndrome is rarely spontaneous; for its debut, the influence of certain factors is required. Effort syndrome – this is sometimes called this thrombosis in medical practice.
Symptoms of Paget-Schretter Syndrome
The disease goes 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-Schretter syndrome are as follows:
In the armpit, or in the area of uXNUMXbuXNUMXbthe collarbone, severe pain occurs. It is unexpected for a person, as it appears suddenly. The nature of the pain is dull, bursting. Sometimes it is possible to experience a migrating burning sensation in various places of the shoulder and forearm.
There is a feeling of warmth or heat in the area of inflammation.
Along the course of the vein, redness or blueness of the skin is possible.
The edema spreads from the hand to the subclavian region and peaks 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 part of the chest.
The distal limbs become cyanotic.
In the region of the armpit, near the neck on the affected side, a venous network begins to appear.
In the cubital fossa and near the forearm, the vessels strongly swell and expand, which indicates the inability of the collaterals to cope with the outflow of blood.
If thrombosis extends to the brachial and axillary veins, then the disease acquires a severe course. The edema increases, blocking the pulse on the radial artery, the affected limb becomes cold, there is a risk of gangrene.
As the disease regresses, a reverse development of the clinical picture is observed, although it is not always possible to achieve complete disappearance of symptoms.
If such symptoms occur, timely treatment is required, as the risk of developing a pulmonary embolism increases.
Causes of Paget-Schretter Syndrome
The causes of Paget-Schretter syndrome are various, among them:
There is a predisposition to the formation of the syndrome in people with a high standing of the first rib. The risk of thrombosis increases with hypertrophy of the subclavian muscle and the tendon part of the pectoralis minor muscle.
Sports or heavy physical labor often lead to compression of the subclavian muscle as a result of pronounced tension of the muscles of the shoulder girdle in combination with movements of the shoulder joint. The muscle is clamped by the clavicle and the first rib.
Weight lifting is a risk factor.
Posture disorders increase the risk of deep subclavian vein thrombosis.
Bone pathologies (growth of the cervical vertebrae, the presence of an additional cervical rib) negatively affect.
Provocative factors are previous fractures of the clavicle, especially those accompanied by the appearance of callus.
The position of the hand during sleep matters. The posture in which the head of a person lies on the shoulder negatively affects.
So, essential for the development of Paget-Schretter syndrome is:
Pronounced physical stress on the vein;
Her long-term systematic traumatization.
Treatment of Paget-Schretter syndrome
The 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, removal of spasm, elimination of inflammation, normalization of microcirculation in tissues.
The patient is not shown strict bed rest, however, for the injured hand, it is necessary to ensure maximum comfort. 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 then intramuscularly.
Immediately after the manifestation of the syndrome, doctors prescribe flavonoids to the patient: Venoruton, Detralex, Troxevasin, Aescusan, Glivenol. These drugs can eliminate pain and inflammation, improve metabolic processes.
To stop the spasm, improve blood flow, intravenous administration of Trental or Xanthinol is prescribed. Orally, after the elimination of the acute phase, you can take No-shpu, Galidor, Papaverine.
The indication for surgical intervention is the threat of gangrene formation, severe hemodynamic disturbances.
If the disease is chronic, then it is possible to perform vascular operations aimed at reconstructing the vein in order to improve venous outflow.
As for the prognosis, in general it is favorable, however, a full recovery may not occur. Severe complications such as gangrene or thromboembolism are rare.