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"Effort" thrombosis of the subclavian vein in a competitive swimmer

Department of Vascular Surgery, Columbia Regional Hospital, Columbia, Missouri

Jack E. Jensen, MD

Department of Orthopedic Surgery, Columbia Regional Hospital, Columbia, Missouri

"Effort" thrombosis is a unique form of subclavian and axillary vein thrombosis because it is the result of an unusual variant of the thoracic outlet syndrome. An other cause of subclavian vein thrombosis is local com pression from trauma, tumor, or development anoma lies ; a third is intimal damage from indwelling central venous catheters. This is a case report of "effort" thrombosis of the subclavian vein in a competitive swimmer. A recently developed technique of local in fusion of low-dose streptokinase therapy is used for clot lysis. Early diagnosis is essential for effective thrombus dissolution with streptokinase. The rationale, risk, and method of streptokinase administration are discussed. Since "effort" thrombosis is secondary to thoracic outlet syndrome (TOS), decompression of the thoracic outlet by removal of the first rib after clot lysis is recommended.

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