Subclavian Vein

Subclavian vein is a large paired vein on either side of the body that drains the blood from the upper extremities, returning the blood to the heart.

Subclavian vein structure:

This veins run from the outer border of the first rib to the medial border of the anterior scalene muscle, where they join with the internal jugular vein to form the brachiocephalic vein (also known as the innominate vein). The venous angle is the angle of the union.

It lies anterior to the anterior scalene and separates the subclavian artery from it. Subclavian venous branches lie anterior to the anterior scalene, while the subclavian artery branches lie posterior to the anterior scalene. The middle scalene is also anterior to the anterior scalene.

 

Function:

In addition to carrying lymphatic fluid (water and solutes), it transports chylomicrons or chyle that are formed in the intestines from dietary fats and lipids. As a consequence, the left subclavian vein is a key player in the absorption of fats and lipids. The products of fats and lipids can then be carried by the bloodstream to the portal vein, and then to the liver.

Within the right internal jugular vein lies the right subclavian vein, which drains lymph into the right lymphatic duct.

 

Axillo subclavian vein thrombosis: how does it happen?

Paget-Schroetter Syndrome, also called axillo-subclavian vein thrombosis, is a rare condition in the general population. It is, however, one of the most common vascular conditions in young athletes. A vein in the armpit (axilla) or the front of the shoulder becomes compressed by the collarbone (clavicle), the first rib, or the surrounding muscles. It is considered to be a symptom of thoracic outlet syndrome.

 

What is deep vein thrombosis?

Blood clots in deep veins, also known as venous thrombosis, are lumps that form in veins deep within the body. The clot may partially or completely prevent blood from flowing through the vein. There are many DVTs that occur in the leg, thigh, and pelvis, but they can appear in other parts of the body, such as the arm, the brain, the intestines, the liver, and the kidney.

 

Axillo-subclavian vein thrombosis: what are the symptoms?

If there is a blood clot in your vein, your doctor will likely use several imaging tests. You won’t have to have all of these tests, but you may be asked to have several.A few of them are:

  • Duplex ultrasound
  • Catheter-directed contrast venography
  • CTA (computerized tomography arteriography)
  • MRA (magnetic resonance arteriography)

An axillo-subclavian vein thrombosis specialist may also order blood tests to detect whether a genetic condition is causing the thrombosis. Some genetic conditions, particularly hypercoagulable syndromes, induce skin clots. Your doctor will order blood tests to monitor how long it takes your blood to clot, including factor V Leiden mutations, Lupus anticoagulants, and others.

 

Axillo-subclavian vein thrombosis: what are the symptoms?

When thrombosis occurs in the arm and hand, the following symptoms can occur:

  • Sudden swelling
  • Bluish skin color
  • Heaviness and pain

Additionally, the condition can cause swelling and puffiness around the eyes, neck, face, and the area around the cheekbone, as well as the face appearing slightly blue on the affected side.

 

When patients have axillo-subclavian vein thrombosis, what is the recommended treatment?

When symptoms of axillo-subclavian vein thrombosis begin, almost all young adults who suffer from it visit their doctor within the first two weeks. Early treatment with thrombolytics (medications to dissolve clots) can cure the condition. An artery or vein is inserted with a catheter to deliver medication to the patient. When a single clot is visible during an imaging test, the vascular specialist may recommend a mechanical thrombectomy. The thrombectomy procedure uses thrombolytic medications and breaking up the clot as well as suction thrombectomy to remove the clot.

 

Deeper in treatment:

Patients are then provided with blood thinners to prevent other clots from developing after the clot is removed (thrombolysis). They begin with heparin and then move on to warfarin (coumadin) for an extended period of time.

A doctor may also ask you:

  • On the affected arm, wear a compression sleeve
  • Exercise your arms by elevating them
  • Don’t use your arm until symptoms have subsided
  • Exercise physical therapy

 

Who suffers from Paget Schroetter Syndrome?

Paget Schroetter syndrome (PSS) is a venous variation of thoracic outlet syndrome (TOS) that is caused by thrombosis of the axillary and subclavian veins caused by effort. The subclavian syndrome occurs whenever the subclavian vein, subclavian artery, or brachial plexus are compressed at the thoracic outlet. An individual with spontaneous thrombosis of the subclavian vein was described by Sir James Paget in 1875.

 

What is the treatment for subclavian vein thrombosis?

Thrombolitic therapy is recommended for patients with effort-induced vein thrombosis lasting less than two weeks. Chronic ASVT does not respond well to thrombolytic therapy. Patients with severe symptoms often require a surgical bypass if warfarin is ineffective. According to the professor’s systematic review, first-rib resection and long-term anticoagulation are the most effective treatments for chronic subclavian vein thrombosis. 

A central line with ASVT usually does not require surgery.  

 

Subclavian vein stenosis: what is it?

Subclavian vein stenosis is characterized by narrowing of the vein, which can lead to a variety of symptoms such as swelling, pain, paresthesia, neck pain, or headaches. The development of deep vein thrombosis (DVT) can further complicate stenosis of the subclavian vein.