Three patients, 2 women aged 42 and 20 years and a 21-year-old man, presented with painful swelling of the upper extremity. The symptoms developed after activities involving repetitive, excessive use of the upper extremity. Duplex examination and venography showed thrombosis of the subclavian vein. This specific type of thrombosis is known as effort thrombosis or Paget-von Schroetter syndrome. It results from a narrowed thoracic outlet combined with repetitive strenuous use of the upper extremity. All three patients were first treated with thrombolytic therapy using urokinase delivered locally in the thrombus with a catheter. After the thrombus had resolved, a first rib resection was performed to decompress the thoracic outlet. Due to the remaining substantial stenosis and vessel wall irregularity, additional percutaneous transluminal angioplasty was performed. It is important to treat effort thrombosis immediately and adequately. Otherwise, it may lead to a postthrombotic syndrome, which can be severely disabling.
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