A 19-year-old competitive swimmer develops sudden swelling and heaviness of the entire left upper limb after an intense training session. Prominent superficial shoulder veins appear within hours. Duplex shows axillary and subclavian vein thrombosis. After initial anticoagulation, what is the preferred definitive management?
- A Six months of compression bandaging alone
- B Open thrombectomy with arteriovenous fistula creation
- C Catheter-directed thrombolysis followed by first rib resection ✓
- D Permanent therapeutic anticoagulation with a DOAC
Correct answer: C. Catheter-directed thrombolysis followed by first rib resection
Explanation
Effort thrombosis of the axillary subclavian vein (Paget-Schroetter syndrome) results from compression of the vein in the costoclavicular space by repetitive overhead activity. Best results come from prompt catheter-directed thrombolysis to clear the vein, followed by decompression of the thoracic outlet, usually first rib resection, to remove the mechanical cause. Anticoagulation alone leaves residual obstruction and high rates of post-thrombotic symptoms in these young active patients.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.