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Subclavian Artery Thrombosis Workup

  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: John Geibel, MD, DSc, MSc, MA  more...
Updated: Sep 14, 2015

Laboratory Studies

Laboratory studies that may be useful include the following:

  • Complete blood count (CBC), 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 (PT) and activated partial thromboplastin time (aPTT) - 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

Imaging Studies

Arteriography is a vital component of the evaluation process with regard to determining the anatomic aberrations of the arterial system and planning possible therapeutic interventions. Include a venous runoff as well because accompanying subclavian vein pathology should not be overlooked.

Computed tomography (CT) can help define bony pathology of the thoracic outlet that may contribute to occlusion of the subclavian artery.

Magnetic resonance arteriography (MRA) is a useful modality for defining subclavian artery anatomy and pathology.[6]

Echocardiography should be obtained in order to evaluate possible sources of arterial emboli.

Contributor Information and Disclosures

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

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Daniel S Schwartz, MD, FACS Medical Director of Thoracic Oncology, St Catherine of Siena Medical Center, Catholic Health Services

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

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MSc, 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; American Gastroenterological Association Fellow

John Geibel, MD, DSc, MSc, 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, Society for Surgery of the Alimentary Tract

Disclosure: Received royalty from AMGEN for consulting; Received ownership interest from Ardelyx for consulting.

Additional Contributors

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, Society for Vascular Surgery

Disclosure: Nothing to disclose.

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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.
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