Primary upper extremity deep venous thrombosis (DVT), or effort thrombosis, typically occurs in young, healthy individuals with a history of repetitive upper extremity movement while secondary upper extremity DVT is associated with a number of predisposing factors. The role of factors such as hypercoagulability in the development of effort thrombosis is less well described. This report describes a previously healthy 21-year-old man who presented with simultaneous bilateral upper extremity DVT after hours of pushing and lifting a heavy wheelbarrow. Treatment included thrombolytic therapy followed by delayed venolysis and vein patch angioplasty. Hypercoagulable screening revealed factor V Leiden heterozygous characteristics.
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References
1.
1. Azakie A, McElhinney DB, Thompson RW, et al: Surgical management of subclavian-vein effort thrombosis as a result of thoracic outlet compression. J Vasc Surg28:777-786, 1998.
2.
2. Machleder HI: Effort thrombosis of the axillosubclavian vein: A disabling vascular disorder. Compr Ther17:18-24, 1991.
3.
3. Haire WD: Arm vein thrombosis. Clin Chest Med16:341-351, 1995.
4.
4. Adelman MA, Stone DH, Riles TS, et al: A multidisciplinary approach to the treatment of Paget-Schroetter syndrome. Ann Vasc Surg11:149-154, 1997.
5.
5. Gloviczki P, Kazmier FJ, Hollier LH: Axillary-subclavian venous occlusion: The morbidity of a nonlethal disease. J Vasc Surg4:333-337, 1986.
6.
6. Lee MC, Grassi CJ, Belkin M, et al: Early operative intervention after thrombolytic therapy for primary subclavian vein thrombosis: An effective treatment approach. J Vasc Surg27:1101-1107,; discussion 1107-11081998.
7.
7. Urschel HC Jr, Razzuk MA: Improved management of the Paget-Schroetter syndrome secondary to thoracic outlet compression. Ann Thorac Surg52:1217-1221, 1991.
8.
8. Machleder HI: Evaluation of a new treatment strategy for Paget-Schroetter syndrome: Spontaneous thrombosis of the axillary-subclavian vein. J Vasc Surg17:305-315,; discussion 316-3171993.
9.
9. Druy EM, Trout HH, Giordano JM, et al: Lytic therapy in the treatment of axillary and subclavian vein thrombosis. J Vasc Surg2:821-827, 1985.
10.
10. Lee WA, Hill BB, Harris EJ Jr, et al: Surgical intervention is not required for all patients with subclavian vein thrombosis. J Vasc Surg32:57-67, 2000.
13. Hingorani A, Ascher E, Yorkovich W, et al: Upper extremity deep venous thrombosis: An underrecognized manifestation of a hypercoagulable state [in process citation]. Ann Vasc Surg14:421-426, 2000.
14.
14. Koster T, Rosendaal FR, de Ronde H, et al: Venous thrombosis due to poor anticoagulant response to activated protein C: Leiden Thrombophilia Study [see comments]. Lancet342:1503-1506, 1993.
15.
15. Bick RL, Kaplan H: Syndromes of thrombosis and hypercoagulability. Congenital and acquired causes of thrombosis. Med Clin North Am82:409-458, 1998.
16.
16. Dahlback B: Activated protein C resistance and thrombosis: Molecular mechanisms of hypercoagulable state due to FVR506Q mutation. Semin Thromb Hemost25:273-289, 1999.
17.
17. Engel H, Zwang L, van Vliet HH, et al: Phenotyping and genotyping of coagulation factor V Leiden. Thromb Haemost75:267-269, 1996.
18.
18. Dahlback B: Resistance to activate protein C, the Arg5O6 to Gln mutation in the factor V gene, and venous thrombosis. Functional tests and DNA-based assays, pros and cons [see comments]. Thromb Haemost73:739-742, 1995.
19.
19. Alving B: Update on recognition and management of patients with acquired or inherited hypercoagulability. Compr Ther24:302-309, 1998.
20.
20. Green RM, Waldman D, Ouriel K, et al: Claviculectomy for subclavian venous repair: Long-term functional results. J Vasc Surg32:315-321, 2000.
