UNASSIGNED: This study aims to examine predisposing anatomic factors and subsequent post-decompression functional outcomes among high-intensity athletes with thoracic outlet syndrome (TOS).
UNASSIGNED: A single-institution retrospective review was performed on a prospective database of patients with TOS from 2018 to 2023 who had undergone operative decompression for TOS. Demographics, TOS characteristics, predisposing anatomy, operative details, and postoperative outcomes were examined. The primary outcome was postoperative return to sport. Secondary outcomes included vascular patency.
UNASSIGNED: A total of 13 patients who were engaged in high-demand athletic activity at the time of their diagnosis were included. Diagnoses included 8 (62%) patients with venous TOS, 4 (31%) patients with neurogenic TOS, and 1 (8%) patient with arterial TOS. Mixed vascular and neurogenic TOS was observed in 3 (23%) patients. The mean age of the cohort was 30 years. Abnormal scalene structure was observed in 12 (92%) patients, and abnormal bone structures were noted in 4 (27%) patients; 2 (15%) with cervical ribs and 3 (23%) patients with clavicular abnormalities. Prior ipsilateral upper extremity trauma was reported in 4 (27%) patients. Significant joint hypermobility was observed in 8 (62%) patients with a median Beighton score of 6. Supraclavicular cervical and/or first rib resection with scalenectomy was performed in all patients. One case of postoperative pneumothorax was treated non-operatively. Ten (77%) patients returned to sport. Duplex ultrasonography showed subclavian vein patency in all 8 patients with venous TOS and wide patency with no drop in perfusion indices in the patient with arterial TOS.
UNASSIGNED: Athletes with TOS who required operative intervention had a high incidence of musculoskeletal aberrations and joint hypermobility. Supraclavicular decompression was associated with a high success rate, with overall good functional outcomes and good likelihood of patients returning to preoperative high-intensity athletics.

UNASSIGNED: Axillary-subclavian venous thrombosis (ASVT) is a type of upper extremity deep vein thrombosis (UEDVT). UEDVTs are classified as either primary or secondary depending on their etiology. Although uncommon, clinicians should be aware of the clinical presentation of UEDVT as timely diagnosis and early treatment is critical in preventing possible post-thrombotic complications.
UNASSIGNED: We report a rare case of axillary-subclavian and internal jugular vein thrombosis in the absence of clear risk factors in a 78-year-old male weightlifter who presented to the office with two-week duration of left upper extremity pain and swelling following strenuous exercise at the gym.
UNASSIGNED: The combination of unusual thrombi location, in addition to the unusual absence of existing thoracic-outlet compression or indwelling medical hardware, makes our case of UEDVT especially uncommon. Clinicians should be aware of this rare disease due to the debilitating effects both in the short and long term.
Thrombose veineuse axillaire-sous-clavière à la suite d’un exercice intense chez un patient âgé: un rapport de cas.
UNASSIGNED: La thrombose veineuse axillaire-sous-clavière (TVAS) est un type de thrombose veineuse profonde du membre supérieur (TVPMS). Les thromboses veineuses profondes du membre supérieur sont classées comme primaires ou secondaires selon leur étiologie. Bien qu’elles soient peu fréquentes, les cliniciens doivent connaître la présentation clinique de la thrombose veineuse profonde du membre supérieur, car un diagnostic et un traitement précoces sont essentiels pour prévenir d’éventuelles complications postthrombotiques.
UNASSIGNED: Nous présentons un cas rare de thrombose de la veine axillaire-sous-clavière et de la veine jugulaire interne en l’absence de facteurs de risque clairs chez un haltérophile de 78 ans qui s’est présenté à la clinique avec une douleur et un gonflement du membre supérieur gauche survenus deux semaines après un exercice physique intense à la salle de sport.
La combinaison de la position inhabituelle des thrombus, en plus de l’absence inhabituelle de compression de l’orifice inférieur du thorax ou de matériel médical à demeure, rend notre cas de thrombose veineuse profonde du membre supérieur particulièrement rare. Les cliniciens doivent connaître cette maladie rare en raison de ses effets débilitants à court et à long terme.

Catheter-related thrombosis (CRT) is a relatively frequent and potentially fatal complication arising in patients with cancer who require a central catheter placement for intravenous treatment. In everyday practice, CRT remains a challenge for management; despite its frequency and its negative clinical impact, few data are available concerning diagnosis and treatment of CRT. In particular, no diagnostic studies or clinical trials have been published that included exclusively patients with cancer and a central venous catheter (CVC). For this reason, many questions regarding optimal management of CRT remain unanswered. Due to the paucity of high-grade evidence regarding CRT in cancer patients, guidelines are derived from upper extremity DVT studies for diagnosis, and from those for lower limb DVT for treatment. This article addresses the issues of diagnosis and management of CRT through a review of the available literature and makes a number of proposals based on the available evidence. In symptomatic patients, venous ultrasound is the most appropriate choice for first-line diagnostic imaging of CRT because it is noninvasive, and its diagnostic performance is high (which is not the case in asymptomatic patients). In the absence of direct comparative clinical trials, we suggest treating patients with CRT with a therapeutic dose of either a LMWH or a direct oral factor Xa inhibitor, with or without a loading dose. These anticoagulants should be given for a total of at least 3 months, including at least 1 month after catheter removal following initiation of therapy.

This article presents a case of a multimorbid 63-year-old woman with chronic kidney disease and heparin-induced thrombocytopenia (HIT). Following the insertion of a central venous catheter, she developed phlegmasia cerulea dolens (PCD) in her left arm, a rare and severe complication of deep vein thrombosis (DVT). Given the severity of the case, adapting to anticoagulant contraindications or unavailability, management with catheter-directed thrombolysis and mechanical thrombectomy was made. It is concluded that catheter-directed thrombolysis and mechanical thrombectomy are valuable therapeutic alternatives in critical situations where treatment options are limited.

暂无摘要。

BACKGROUND: Current management of axillosubclavian deep venous thrombosis (DVT) often uses thrombolysis for the DVT, prompt first rib removal, and occasional venoplasty or stenting. Our institution has increasingly used anticoagulation alone followed by interval first rib resection. We sought to analyze the effectiveness of this simplified technique.
METHODS: Between September 2012 and April 2021, 27 patients were identified within the institution\'s electronic medical record as having undergone first rib resection for upper extremity DVT. Seven of these patients had undergone preoperative thrombolysis before referral and were excluded. Among the remaining 20 patients, preoperative clinic charts were evaluated for age, venous segment involvement, contralateral limb involvement, presence of documented hypercoagulable state, duration of preoperative and postoperative anticoagulation, and postoperative outcomes.
RESULTS: Of the 20 patients (mean age, 26.2 years; 13 males) presenting with acute axillosubclavian DVT, all patients had right (n = 8) or left (n = 12) arm swelling. Five patients had extremity pain and four had extremity discoloration. Ten had axillosubclavian vein involvement, 9 had subclavian vein involvement, and 1 had axillary vein involvement. Two patients were on oral contraceptives and no patients had any other diagnosed hypercoagulable conditions. The mean duration of preoperative and postoperative anticoagulation was 3.2 ± 2.6 months and 2.1 ± 2.1 months, respectively. Nineteen patients underwent supraclavicular first rib resection and 1 patient underwent transaxillary resection. Twelve patients (60%) demonstrated complete DVT resolution by venous duplex examination during the postoperative period and 8 patients (40%) demonstrated partial recanalization/chronic DVT. Complications included one hemothorax and one thoracic duct injury. All 20 patients remain asymptomatic without arm swelling, with a mean follow-up of 55.1 ± 34.7 months.
CONCLUSIONS: Among patients presenting with acute axillosubclavian DVT, anticoagulation alone followed by interval first rib resection proved to be successful in providing symptomatic relief in the short to medium term. By eliminating the need for preoperative thrombolysis and postoperative venograms, this potentially cost-saving algorithm simplifies our management for acute venous thoracic outlet syndrome while maintaining good clinical outcomes. Because this study only analyzed our management algorithm\'s effectiveness in the short to medium term, the long-term effectiveness of this treatment will need to be demonstrated.

This study aimed to investigate the conditions of patients with peripherally inserted central catheter (PICC) placements, analyze the risk factors influencing thrombosis in PICC-placed patients, and formulate more accurate and effective PICC management strategies. A total of 147 patients undergoing PICC placements were selected as the study subjects. Clinical data were collected, and the patients were divided into thrombosis and non-thrombosis groups. Detect levels of bilirubin, white blood cells, venous pressure, heparin concentration, blood flow, citric acid, and platelets. Pearson chi-square test, Spearman correlation analysis, as well as univariate and multivariate logistic regression were employed to analyze independent risk factors. Among the 147 patients with PICC placements, there were 84 males and 63 females. Thrombosis occurred in 116 cases, with an incidence rate of 78.91%. Pearson chi-square test showed a significant correlation between citric acid, blood flow, platelets and frailty (P < .001) with thrombosis formation. Spearman correlation analysis revealed a significant correlation between citric acid (ρ = -0.636, P < .001), blood flow (ρ = 0.584, P < .001), platelet count (ρ = 0.440, P < .001), frailty (ρ = -0.809, P < .001) and thrombosis in PICC placement patients. Univariate logistic regression analysis indicated a significant correlation between thrombosis formation and citric acid (OR = 0.022, 95% CI = 0.006-0.08, P < .001), blood flow (OR = 33.973, 95% CI = 9.538-121.005, P < .001), platelet count (OR = 22.065, 95% CI = 5.021-96.970, P < .001), frailty (OR = 0.003, 95% CI = 0.001-0.025, P < .001). Multivariate logistic regression analysis also showed a significant correlation between thrombosis formation and citric acid (OR = 0.013, 95% CI = 0.002-0.086, P < .001), blood flow (OR = 35.064, 95% CI = 6.385-192.561, P < .001), platelet count (OR = 4.667, 95% CI = 0.902-24.143, P < .001), frailty (OR = 0.006, 95% CI = 0.001-0.051, P < .001). However, gender (OR = 0.544, 95% CI = 0.113-2.612, P = .447), age (OR = 4.178, 95% CI = 0.859-20.317, P = .076), bilirubin (OR = 2.594, 95% CI = 0.586-11.482, P = .209), white blood cells (OR = 0.573, 95% CI = 0.108-3.029, P = .512), venous pressure (OR = 0.559, 95% CI = 0.129-2.429, P = .438), and heparin concentration (OR = 2.660, 95% CI = 0.333-21.264, P = .356) showed no significant correlation with thrombosis formation. Patients with PICC placements have a higher risk of thrombosis, citric acid, blood flow, platelet count and frailty are the main risk factors.

The frequency of upper extremities vein thrombosis (UEVT) is rising with the increasing use of endovenous devices. These thromboses are particularly common among hospitalized patients. The epidemiology and risk factors for UEVT are poorly understood in a hospitalized population.
To assess the prevalence of UEVT in hospitalized patients and study thrombosis risk factors according to their location.
Prospective evaluation of patients hospitalized in a university hospital with clinical and Doppler ultrasound (DUS) assessment of the upper extremities.
Of the 400 patients included, 91(22.8 %) had UEVT including 8 (8.8 %) proximal thrombosis, 32 (35.2 %) arm venous thrombosis and 51 (56.0 %) forearm venous thrombosis; 7 (7.7 %) patients with UEVT had a concomitant symptomatic pulmonary embolism. In this population of hospitalized patients, 40 (10 %) had proximal or arm thrombosis and 51 (12.8 %) forearm thrombosis. All patients with UEVT had a venous catheter and 63 (69.2 %) of UEVT patients had therapeutic or prophylactic anticoagulation at the time of DUS evaluation. In multivariate analysis, peripheral intravenous catheter (PIVC) OR 3.71 [1.90; 7.91] (p < 0.001); MID line OR 3.58 [1.46; 8.91] (p = 0.005) and infection disease OR 2.21 [1.26; 4386] (p = 0.005) were associated with UEVT. Central venous catheter OR 66.24 [12.64; 587.03] was associated with proximal UEVT and MID line OR 12.61 [4.64; 35.77] (p < 0.001) with arm UEVT. Forearm UEVT were associated with PIVCOR 10.71[3.14; 67.37] (p = 0.001); infectious disease OR 2.87 [1.48; 5.60] (p = 0.002), iron infusion OR 3.11 [1.23; 7.47] and hospitalization for postpartum OR 4.37 [0.97; 18.06] (p = 0.04).
One in 5 hospitalized patients suffers from UEVT. Proximal venous thrombosis is uncommon. The presence of a catheter and hospitalization for infection are the factors most frequently associated with UEVT.

Catheter-related thrombosis (CRT) is a relatively frequent and potentially fatal complication arising in patients with cancer who require a central catheter placement for intravenous treatment. In everyday practice, CRT remains a challenge for management; despite its frequency and its negative clinical impact, few data are available concerning diagnosis and treatment of CRT. In particular, no diagnostic studies or clinical trials have been published that included exclusively patients with cancer and a central venous catheter (CVC). For this reason, many questions regarding optimal management of CRT remain unanswered. Due to the paucity of high-grade evidence regarding CRT in cancer patients, guidelines are derived from upper extremity DVT studies for diagnosis, and from those for lower limb DVT for treatment. This article addresses the issues of diagnosis and management of CRT through a review of the available literature and makes a number of proposals based on the available evidence. In symptomatic patients, venous ultrasound is the most appropriate choice for first-line diagnostic imaging of CRT because it is noninvasive, and its diagnostic performance is high (which is not the case in asymptomatic patients). In the absence of direct comparative clinical trials, we suggest treating patients with CRT with a therapeutic dose of either a LMWH or a direct oral factor Xa inhibitor, with or without a loading dose. These anticoagulants should be given for a total of at least three months, including at least one month after catheter removal following initiation of therapy.

BACKGROUND: Patients with cancer commonly require a central venous catheter, which is associated with an increased risk of venous thromboembolism (VTE). Despite the frequent occurrence, the optimal anticoagulation management and outcomes for patients with cancer and catheter-related upper extremity deep vein thrombosis (DVT) are unclear.
OBJECTIVE: We performed a systematic review and meta-analysis to evaluate the rates of recurrent VTE and bleeding in patients with cancer and catheter-related upper extremity DVT.
METHODS: We searched MEDLINE, Embase, Scopus, and CENTRAL from inception to June 2, 2023. The primary efficacy outcome was recurrent VTE, and the primary safety outcome was major bleeding. The incidence rates (with 95% CI) of outcomes were pooled using random effects model.
RESULTS: We included 29 studies (N = 2,836), among which 5 were prospective. The duration of follow-up and anticoagulation varied considerably. The main long-term anticoagulant used was low molecular weight heparin, followed by direct oral anticoagulants. The pooled 3-month recurrent VTE rate from 14 studies (N = 1,128) was 0.56% (95% CI, 0.10%-3.01%; I2 = 0%). The pooled 3-month major bleeding rate from 10 studies (N = 834) was 2.34% (95% CI, 1.14%-4.76%; I2 = 0%). We were unable to pool event rates beyond 3 months, given high heterogeneity. All studies had serious risk of bias.
CONCLUSIONS: Our study demonstrated a relatively low rate of recurrent VTE and moderate rate of major bleeding events within the first 3 months in patients with cancer and catheter-related upper extremity DVT. However, there was significant heterogeneity in the management and reporting after 3 months.