Upper limb deep vein thrombosis
ICD-10 I82.6 · ICD-11 BD71.0

Treatment of Upper Limb DVT in Venous Thoracic Outlet Syndrome (Paget-Schroetter Syndrome)

Clinical Scenario

This protocol addresses upper limb deep vein thrombosis occurring in the setting of venous thoracic outlet syndrome (VTOS) — also known as effort-related thrombosis or Paget-Schroetter syndrome. Most patients with effort-related upper extremity DVT have an underlying VTOS, in which anatomic abnormalities within the anterior part of the thoracic outlet triangle cause compression of the subclavian vein.

Treatment Approach

Management requires a multidisciplinary approach. This includes anticoagulation and thrombolysis strategies to address the acute thrombosis, followed by surgical correction targeting the underlying thoracic outlet compression. When symptoms persist after initial treatment, additional interventional steps may be indicated.

The complete regimen — including specific interventions, sequencing, and the algorithm for persistent obstruction — is available in the full protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1161/circulationaha.111.051276

Most patients with effort-related UEDVT have an underlying venous thoracic outlet syndrome (VTOS).

VTOS results in compression of the subclavian vein because of anatomic abnormalities within the anterior part of the thoracic outlet triangle.

A multidisciplinary approach consisting of anticoagulation therapy, CDT, or pharmacomechanical thrombolysis and subsequent surgical correction of VTOS is the current standard of care.

Surgical decompression involves resection of the first rib and costoclavicular ligament, anterior scalenectomy, and venolysis.

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