![]() VTOS reflects a spectrum of disease secondary to anatomical narrowing in the costoclavicular triangle, which may result in thrombosis of the subclavian-axillary veins causing acute symptoms such as pain and upper extremity swelling. First described by Sir James Paget in 1875 and later correctly attributed to venous thrombosis by Von Schroetter in 1884 ( 2, 3), the term Paget-Schroetter’s Syndrome (PSS) was introduced about 70 years later by Hughes in 1949 in a report describing a large series of patients with this condition ( 4). Venous thoracic outlet syndrome (vTOS) or extrinsic subclavian vein compression is one of the well-defined diagnoses for this condition. Upper extremity central venous thrombosis is an increasingly common condition secondary to a wide variety of differential diagnosis ( 1, 2). CDT combined with medical anticoagulation and surgical decompression are the components of most treatment algorithms for the management of patients suffering from PSS. ![]() Catheter-directed therapies (CDT) have also a pivotal role as the initial treatment to resolve the acute thrombosis and establish venous patency. ![]() Like any other condition involving the thrombosis of deep venous system, initial step in the management is anticoagulation. Following diagnosis, multiple algorithms exist for the management of PSS and almost all require a multidisciplinary approach. Several noninvasive imaging techniques are currently available to confirm the initial diagnosis including Doppler ultrasound, contrast-enhanced computed tomography, and magnetic resonance imaging. Early diagnosis and aggressive early intervention aimed at complete resolution of acute symptoms and minimizing the risk of recurrence is ultimately important and increases the likelihood of the full restoration of limb function. PSS or effort thrombosis mostly affects young otherwise healthy active individuals, and this further highlights the importance of this condition. Paget-Schroetter’s Syndrome (PSS) or effort thrombosis is a subtype of vTOS where compression and microtrauma to subclavian vein from repetitive arm movements results in venous thrombosis. Venous thoracic outlet syndrome (vTOS) is a spectrum of disease caused by external compression of the subclavian vein as it passes through the costoclavicular space.
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