Subclavian Artery Thrombosis Workup

  • Author: Mary C Mancini, MD, PhD; Chief Editor: John Geibel, MD, DSc, MA   more...
 
Updated: Nov 15, 2011
 

Laboratory Studies

  • Complete blood cell count, platelet count, and basic chemistry profile: Results should be within reference ranges; however, abnormalities in these parameters could be early indicators of dehydration or a hypercoagulable state.
  • Prothrombin time, activated partial thromboplastin time: Again, results should be within reference ranges; however, they should be checked in order to assess the patient's coagulation profile.
  • Antithrombin III level: In a hypercoagulable state, the antithrombin III level is low.
  • Alpha-macroglobulin, plasminogen levels: Low levels indicate a prothrombotic state.
  • Fibrinogen, factor VII, and factor VIII levels: Elevated levels indicate a prothrombotic state.
  • Protein C and S levels: Abnormalities in these parameters indicate a chronic inflammatory state.
  • Factor V Leiden and factor II C20210-a levels should also be assessed.
Next

Imaging Studies

  • Arteriography: This is a vital component of the evaluation process in order to determine the anatomical aberrations of the arterial system and to plan possible therapeutic interventions. Include a venous runoff as well because accompanying subclavian vein pathology should not be overlooked.
  • Computerized axial tomography scanning: This study is of assistance in defining bony pathology of the thoracic outlet that may contribute to occlusion of the subclavian artery.
  • Magnetic resonance arteriography: This study is a useful modality for defining subclavian artery anatomy and pathology.[5]
Previous
Next

Other Tests

  • Echocardiography should be obtained in order to evaluate possible sources of arterial emboli.
Previous
Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Mary C Mancini, MD, PhD  Professor and Chief of Cardiothoracic Surgery, Department of Surgery, Louisiana State University School of Medicine in Shreveport

Mary C Mancini, MD, PhD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Surgeons, American Surgical Association, Phi Beta Kappa, Society of Thoracic Surgeons, and Southern Surgical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Jeffrey Lawrence Kaufman, MD  Associate Professor, Department of Surgery, Division of Vascular Surgery, Tufts University School of Medicine

Jeffrey Lawrence Kaufman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Society for Artificial Internal Organs, Association for Academic Surgery, Association for Surgical Education, Massachusetts Medical Society, Phi Beta Kappa, and Society for Vascular Surgery

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Daniel S Schwartz, MD, FACS  Assistant Clinical Professor of Cardiothoracic Surgery, Mount Sinai School of Medicine; Chief of Thoracic Surgery, Huntington Hospital

Daniel S Schwartz, MD, FACS is a member of the following medical societies: American College of Chest Physicians, American College of Surgeons, Society of Thoracic Surgeons, and Western Thoracic Surgical Association

Disclosure: Nothing to disclose.

Paolo Zamboni, MD  Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy

Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA  Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital

John Geibel, MD, DSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, and Society for Surgery of the Alimentary Tract

Disclosure: AMGEN Royalty Consulting; ARdelyx Ownership interest Board membership

References

  1. Nuber GW, McCarthy WJ, Yao JS, Schafer MF, Suker JR. Arterial abnormalities of the shoulder in athletes. Am J Sports Med. Sep-Oct 1990;18(5):514-9. [Medline].

  2. Nehler MR, Taylor LM Jr, Moneta GL, Porter JM. Upper extremity ischemia from subclavian artery aneurysm caused by bony abnormalities of the thoracic outlet. Arch Surg. May 1997;132(5):527-32. [Medline].

  3. Mandalam KR, Rao VR, Gupta AK, Joseph S, Unni NM, Rao AS. Occlusion of an aberrant right subclavian artery arising from a Kommerel diverticulum. J Vasc Interv Radiol. Jul-Aug 1993;4(4):577-9. [Medline].

  4. Zimmerman NB. Occlusive vascular disorders of the upper extremity. Hand Clin. Feb 1993;9(1):139-50. [Medline].

  5. Laitt RD, Thompson JF, Goddard P, Wakeley CJ, Murphy P, Lamont P. Subclavian artery aneurysm: the role of magnetic resonance imaging. Cardiovasc Surg. Oct 1994;2(5):612-4. [Medline].

  6. Rogers JH, Calhoun RF 2nd. Diagnosis and management of subclavian artery stenosis prior to coronary artery bypass grafting in the current era. J Card Surg. Jan-Feb 2007;22(1):20-5. [Medline].

  7. Dave B, Bhatt N, Gupta M, Khalasi Y, Balasubramanya KS. Subclavian artery thrombosis--management with thrombolysis and angioplasty. J Indian Med Assoc. Sep 2004;102(9):519-20, 527. [Medline].

  8. Burihan E, Soma F, Iared W. Angioplasty versus stenting for subclavian artery stenosis. Cochrane Database Syst Rev. Oct 5 2011;CD008461. [Medline].

  9. Fugate MW, Rotellini-Coltvet L, Freischlag JA. Current management of thoracic outlet syndrome. Curr Treat Options Cardiovasc Med. Apr 2009;11(2):176-83. [Medline].

  10. Thompson JF, Webster JH. First rib resection for vascular complications of thoracic outlet syndrome. Br J Surg. May 1990;77(5):555-7. [Medline].

  11. Hood DB, Kuehne J, Yellin AE, Weaver FA. Vascular complications of thoracic outlet syndrome. Am Surg. Oct 1997;63(10):913-7. [Medline].

  12. Cohen JE, Rajz G, Gomori JM, Verstandig A, Berlatzky Y, Anner H, et al. Urgent endovascular stent-graft placement for traumatic penetrating subclavian artery injuries. J Neurol Sci. Sep 15 2008;272(1-2):151-7. [Medline].

  13. Shalhub S, Starnes BW, Hatsukami TS, Karmy-Jones R, Tran NT. Repair of blunt thoracic outlet arterial injuries: an evolution from open to endovascular approach. J Trauma. Nov 2011;71(5):E114-21. [Medline].

  14. Varcoe R, Smith W. Use of a cutting balloon and a paclitaxel-coated balloon to treat recurrent subclavian in-stent restenosis causing coronary subclavian steal syndrome. Cardiovasc Revasc Med. Jul 26 2011;[Medline].

  15. Miyakoshi A, Hatano T, Tsukahara T, Murakami M, Arai D, Yamaguchi S. Percutaneous transluminal angioplasty for atherosclerotic stenosis of the subclavian or innominate artery: angiographic and clinical outcomes in 36 patients. Neurosurg Rev. Jun 4 2011;[Medline].

  16. Baraki H, Hagl C, Khaladj N, Kallenbach K, Weidemann J, Haverich A. The frozen elephant trunk technique for treatment of thoracic aortic aneurysms. Ann Thorac Surg. Feb 2007;83(2):S819-23; discussion S824-31. [Medline].

  17. Boas N, Desmoucelle F, Bernadet V, Franceschi JC. Rare cause of acute ischemia of the right upper extremity: thrombosis of a retroesophageal subclavian artery. Ann Vasc Surg. May 2002;16(3):387-90. [Medline].

  18. Dagenais F, Dumont E, Voisine P. Intramural hematoma of the arch and ascending aorta owing to acute aortic syndrome of the descending aorta: to stent or not to stent?. J Endovasc Ther. Oct 2008;15(5):544-9. [Medline].

  19. Edwards WH. An unsuspected cause for recurrent angina: subclavian artery stenosis. Am Surg. Dec 1995;61(12):1057-60. [Medline].

  20. Fan Z, Roedersheimer R, Lohr J. Systemic thrombolysis using tissue plasminogen activator for a patient with paradoxic embolism: a case report. Vasc Endovascular Surg. Apr-May 2007;41(2):136-9. [Medline].

  21. Golcman L, Berginer VM, Szendro G, Hoda J, Louson Z. Prominent somnolence and cerebellar syndrome in subclavian artery thrombosis--a case report. Angiology. Dec 1987;38(12):912-5. [Medline].

  22. Hay E, Cohen H, Pasik S. Acute thrombosis of subclavian artery during CPR. Ann Emerg Med. Apr 1987;16(4):447-51. [Medline].

  23. Hendler MF, Meschengieser SS, Blanco AN, Alberto MF, Salviú MJ, Gennari L. Primary upper-extremity deep vein thrombosis: high prevalence of thrombophilic defects. Am J Hematol. Aug 2004;76(4):330-7. [Medline].

  24. Henry M, Amor M, Henry I. Percutaneous transluminal angioplasty of the subclavian arteries. J Endovasc Surg. Feb 1999;6(1):33-41. [Medline].

  25. Mendelsohn AM, Buzzard CJ, Lerner NB, Ling FS. Transumbilical balloon angioplasty of subclavian artery thrombosis in a neonate. Catheter Cardiovasc Interv. Jan 2000;49(1):56-60. [Medline].

  26. Rapp JH, Reilly LM, Goldstone J, Krupski WC, Ehrenfeld WK, Stoney RJ. Ischemia of the upper extremity: significance of proximal arterial disease. Am J Surg. Jul 1986;152(1):122-6. [Medline].

  27. Riesenman PJ, Farber MA, Mendes RR, Marston WA, Fulton JJ, Keagy BA. Coverage of the left subclavian artery during thoracic endovascular aortic repair. J Vasc Surg. Jan 2007;45(1):90-4; discussion 94-5. [Medline].

  28. Tyagi S, Rangasetty UC, Kaul UA. Stenting of a large thrombus-containing subclavian artery stenosis using a distal protection device. Indian Heart J. May-Jun 2003;55(3):262-4. [Medline].

  29. Vanherweghem JL, Cabolet P, Dhaene M, Goldman M, Stolear JC, Sabot JP. Complications related to subclavian catheters for hemodialysis. Report and review. Am J Nephrol. 1986;6(5):339-45. [Medline].

  30. Vinsonneau U, Castellant P, Traore A, Cornily JC, Pennec PY, Etienne Y, et al. [Floating thrombus in an aberrant right subclavian artery: a rare cause of peripheral arterial embolic events]. Rev Med Interne. Nov 2008;29(11):908-11. [Medline].

  31. Witz M, Lehman J, Shnaker A, Korzets Z. Acute subclavian and brachial artery thrombosis as a complication of the nephrotic syndrome. Isr Med Assoc J. Jul 2004;6(7):441-2. [Medline].

  32. Witz M, Lehmann J, Korzets Z. Acute brachial artery thrombosis as the initial manifestation of human immunodeficiency virus infection. Am J Hematol. Jun 2000;64(2):137-9. [Medline].

  33. Zeller T, Frank U, Bürgelin K, Sinn L, Horn B, Roskamm H. Acute thrombotic subclavian artery occlusion treated with a new rotational thrombectomy device. J Endovasc Ther. Dec 2002;9(6):917-21. [Medline].

 
Previous
Next
 
The anatomy of the subclavian artery in the thoracic outlet.
Carotid-subclavian bypass for subclavian steal syndrome.
Subclavian-subclavian or axillary-axillary bypass for subclavian artery occlusion.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.