Do you have a blood clot in a vein in your arm? (Axillo-Subclavian Vein Thrombosis) - Let's talk about this!

Do you sometimes feel a sudden sharp pain in your arm, swelling, or a blue color? Or does your arm feel numb or heavy? These are not symptoms to ignore. It could be a blood clot in a large vein in your arm or armpit. In medical terms, we call this (Axillo-Subclavian Vein Thrombosis) or (ASVT) . Don't worry, we'll talk about this in a simple way that you can understand.

What is this (Axillo-Subclavian Vein Thrombosis)?

Simply put, Axillo-Subclavian Vein Thrombosis (ASVT) is when a blood clot forms in either the subclavian vein , a large vein in your shoulder, or the axillary vein, a vein in your armpit. Think of your veins as water pipes. If a rib or piece of meat near this vein gets pressed against it, it can block blood flow and cause a blood clot to form.

This condition is often caused by an injury to your upper arm, or by stress on your arm from repetitive movements. Some people call it Paget-Schroetter syndrome , while others call it effort-induced thrombosis , which means "a blood clot caused by exertion."

Is this (Deep Vein Thrombosis - DVT) rare?

Yes, you can have that problem. (ASVT) is actually a type of condition called (Deep Vein Thrombosis) or (DVT) . (DVT) is when a blood clot forms in a vein deep in the body. But most of the time when we talk about (DVT) we are talking about blood clots that form in the legs. They are often caused by things like obesity, physical inactivity, aging, or other diseases related to the veins.

However, blood clots in the hand, called ASVT, often occur as a result of an accident or from prolonged use of the hand. The symptoms and treatments for these two conditions can sometimes be different.

Who is more likely to develop this (ASVT)?

Although anyone can get this condition, some people are at a higher risk. These include:

• Always active, generally healthy .
• Young people between the ages of 15 and 45 .
• People who play sports (e.g. fast bowlers in cricket, swimmers, weight lifters) or people who work with their arms raised continuously (e.g. painters, electricians, people who do heavy lifting jobs). Just think, when you work with your arms raised and twisted in the same way, pressure is put on those veins.
• People with certain genetic blood clotting disorders .

Are there different types of (ASVT)?

Yes, there are two main types of (ASVT):

1. Primary ASVT:This is the most common type, caused by strenuous, repetitive movements of the hand.

2. Secondary ASVT: This is caused by some medical devices that are implanted in your upper chest. For example:

• (Central venous catheter) (a tube inserted into a main vein)
• (Defibrillator) (a device that restores the functioning of the heart)
• (Pacemaker) (a device that controls the heartbeat)
• (Medication port) (A small device placed under the skin to administer medication)

These devices can also cause blood vessels to constrict and blood clots to form.

How common is (ASVT)?

Actually, ASVT is not a very common condition. According to statistics, it occurs in one or two people in every 100,000 per year. However, only 10% to 20% of all DVTs in the upper extremity are caused by ASVT. So, from that perspective, it is a significant number.

What are the symptoms of (ASVT)?

If you have ASVT, you may experience one or more of these symptoms:

• Hand pain: Sudden onset, sometimes severe.
• Visible veins in the hands: Veins may appear bulging due to constricted blood flow.
• Blue skin color (Cyanosis): The skin on the hands may turn blue. This means that there is a lack of oxygen.
• Feeling of heaviness or fatigue in the hand: You may find it difficult to lift or move your hand.
• Sudden swelling of the hand: The hand suddenly starts to swell.

Importantly, in some cases (10% - 20%) this blood clot can break free from the vein, travel through the bloodstream, and travel to the lungs. This is called a Pulmonary Embolism (PE) . This is a very dangerous condition . It can cause severe damage to the lungs, and can even be life-threatening. Therefore, if you start experiencing any of these symptoms, you should definitely see a doctor without wasting any time.

Why does this (ASVT) occur?

As we mentioned before, the main cause is repetitive movements of the arm. Imagine, you are constantly lifting weights or playing sports. Then the muscles around your shoulder and armpit can become tired and swollen. These swollen muscles can compress the blood vessels there (especially the subclavian or axillary veins).

Over time, this pressure can damage the vein wall and cause scar tissue to form. The vein then narrows from the inside, reducing the amount of blood that can flow through it. This can lead to poor blood flow and an increased risk of blood clots. This condition is sometimes called Thoracic Outlet Syndrome (TOS).It is also called. It means that the space in the upper part of the chest (thoracic outlet) is narrowed, causing pressure on the veins and nerves.

Sometimes, ASVT can be caused by an abnormality in the first rib, or changes in the muscles or ligaments around the veins in the armpit and shoulder area.

How does a doctor diagnose this (ASVT)?

When you go to a doctor with the symptoms mentioned earlier, he or she will first examine you. The doctor will be able to see things like swelling in your hand, changes in color, and bulging veins at a glance.

Then, you may need to do a few tests to make sure:

• (Duplex ultrasound): This is often the first test done. It uses sound waves to look at the blood flow inside the veins and to see if there are any blood clots. This is a painless, easy test.
• Catheter-guided venography: Sometimes this test is done. In this test, a small, thin tube (catheter) is passed through a vein to where the blood clot is thought to be, and a special dye is injected into the vein through the catheter. X-rays are then taken to see where the vein is blocked and how big the clot is.
• (CTA - computerized tomography angiography): This is similar to a CT scan, but it looks specifically at the blood vessels. It is also done by injecting a dye.
• (MRA - magnetic resonance angiography): A test that uses an MRI scan to look at blood vessels.

These tests can determine exactly if the condition (ASVT) is present, where it is, and how severe it is.

What are the treatments for (ASVT)?

The best thing is, there are effective treatments for ASVT. The main treatment is called thrombolysis or thrombolytic therapy .

This involves injecting a medication that dissolves the blood clot and removes it, as mentioned earlier, directly into the vein where the blood clot is located through a small tube (catheter) . This dissolves the blood clot and restores blood flow in the vein.

Sometimes, this (thrombolysis) treatment is accompanied by something called (thrombectomy) . That is, the blood clot is removed either mechanically or through minor surgery.

After these treatments, you will be given blood -thinning medication , such as Warfarin or other modern medications, for several months to prevent blood clots from forming again. It is very important to take this medication for the exact length of time your doctor tells you.

In addition, the doctor will also give you the following advice:

• Reduce use of the affected hand until symptoms subside completely.
• Keep your arms slightly elevated when possible (arm elevations).
• Physical therapyRefer to. This will help you regain movement and strength in your hand.
• Wear a compression sleeve (like a tight sock) on the affected arm. This will help reduce swelling and improve blood circulation.

Will surgery be necessary?

In some cases, yes. Surgery may be recommended to completely remove the blockage and reduce the risk of blood clots forming again. This surgery involves removing the blockage. For example, a piece of the first rib or a piece of meat that is causing the blockage may be removed. This allows blood to flow freely through the vein.

What can we do to prevent the development of (ASVT)?

Although it cannot be completely prevented, there are several things we can do to reduce the risk:

• Always gently move the muscles in your arms and engage in exercises like stretches .
• Don't overwork your hands.
• If you are lifting weights or exercising vigorously, take some rest in between .
• Whenever possible, try to work with your non-dominant arm . (e.g. if you are right-handed, use your left arm when possible).

What will the situation be like after treatment?

Most people with ASVT do very well after treatment. Studies have shown that if the disease is diagnosed and treated early, as soon as symptoms begin, there is a 90% to 95% success rate .

However, some people may develop a complication called Post-thrombotic Syndrome (PTS) . In this, there may be long-term symptoms such as pain, heaviness, and swelling in the affected arm. Therefore, it is important to follow your doctor's instructions even after treatment.

When should we see a doctor as soon as possible?

If you notice any of the first symptoms of ASVT, seek medical advice immediately . Don't delay, especially if you experience any of the following:

• Chest pain
• Numbness in both arms or legs
• Difficulty breathing (dyspnea)

These could be signs of a dangerous condition such as Pulmonary Embolism (PE).

(ASVT) If so, what questions should you ask the doctor?

If your doctor tells you that you have ASVT, it's a good idea to ask some questions like these:

• What lifestyle changes can I make to reduce my risk of blood clots?
• Can I continue to exercise and do manual labor?
• What can I do to prevent blood clots from forming again?
• How long do you need to take blood-thinning medication?

The most important thing to remember (Take-Home Message)

I hope you now have a better understanding of what we discussed today (Axillo-Subclavian Vein Thrombosis - ASVT). In summary:

• (ASVT) is a blood clot that forms in a large vein in your arm or armpit.
• This often happens because the hand is used in a continuous, tiring manner.
• You may suspect it if you experience symptoms such as sudden pain, swelling, and blue skin in your hand.
• Thrombolysis (medication to dissolve blood clots) and thrombectomy (removal of blood clots) are the main treatments.
• The most important thing is to diagnose the disease early and start treatment. If you do, you have a much better chance of making a full recovery.

If you have these symptoms, don't be afraid and see a doctor without delay. Stay healthy!

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