Effort Thrombosis (Paget-Schroetter Syndrome)

Effort thrombosis, also known as Paget-Schroetter Syndrome and venous thoracic outlet syndrome (VTOS), refers to primary thrombosis of the subclavian-axillary vein at the costoclavicular space. Most patients present after experiencing axillo-subclavian vein thrombosis, and the thrombosis often results from vigorous athletic activities requiring repetitive arm and shoulder motions (e.g., weight lifting, swimming)as well as occupations that require repetitive motions with elevated upper extremities  This review covers effort thrombosis in detail, examining its clinical and diagnostic evaluations, treatment, operative and postoperative management, and complications. An algorithm details the approach to the patient with effort thrombosis. Figures include the anatomy of the costoclavicur space, B-mode and duplex color-flow imaging of the proximal left subclavian vein, crossed occlusive thrombus, anatomic landmarks for planning infraclavicular approach incision, rib resection, venoplasty  with an 8 × 40 mm balloon, completion venogram postvenoplasty, the supraclavicular approach  using a self-retaining  retractor system, post resection of the anterior scalene muscle, and post left first