Has your arm suddenly become swollen and blue? Could this be Axillo-Subclavian Vein Thrombosis (ASVT)?

Imagine you are a healthy young man who plays cricket, works out hard at the gym. But suddenly your arm starts to hurt, swells up, and looks a little blue. It is usually thought to be something like a muscle strain. But this can be a more serious, but very treatable condition. Today we are talking about one such condition, 'Axillo-Subclavian Vein Thrombosis' or ASVT for short.

Simply put, what is this ASVT?

Simply put, ASVT is the formation of a blood clot in a deep vein in your upper arm, such as the axillary vein or subclavian vein. This usually happens after an injury to your arm or when you use your arm too much and do the same thing over and over again. This condition is also called Paget-Schroetter syndrome and effort-induced thrombosis.

Is this also a type of DVT? What's the difference?

Yes, ASVT is also a type of deep vein thrombosis (DVT). But when we usually hear about DVT, we hear about blood clots that form in the legs. It is caused by things like sitting in the same position for a long time, obesity, and aging. But this condition called ASVT is much different than that.

You can easily understand this difference from the table below.

Who is more likely to develop this condition?

While this may seem surprising, ASVT is most likely to develop in people who are physically fit, healthy, and active , especially those between the ages of 15 and 45.

Think about people like this:

• People who engage in repetitive exercises or sports that involve lifting their arms, such as fast bowling in cricket, playing volleyball, swimming, or lifting weights.
• People who work in manual jobs, such as painters and electricians.
• People with blood clotting disorders are also at risk.

What are the symptoms of this condition?

Symptoms of ASVT usually appear suddenly. The main symptoms are:

• Pain in the hand.
• The veins in the hands become bulging and clearly visible.
• Blue discoloration of the skin of the hands (Cyanosis).
• A feeling of heaviness or fatigue in the hand.
• Sudden swelling of the hand (this is the most common symptom).

What is the real cause of ASVT?

Here's how it works. Imagine a blood vessel (vein) in your shoulder that's like a water pipe. On either side of this pipe, a rib and a muscle are tightly clamped. When you do an exercise or task that involves lifting your arm, the vein gets pinched between that muscle and the rib, causing it to become injured.

Over time, scar tissue forms at the site of this injury, narrowing the vein even further. This restricts blood flow. That's when blood clots start to form. The underlying condition that causes this vein to become blocked is called thoracic outlet syndrome (TOS).

How do you find this, Doctor?

Based on your symptoms, if your doctor suspects this, he or she will order several tests to confirm the condition after a physical examination.

• Duplex ultrasound: This is the most common test. It uses sound waves to look at how blood flows inside the veins and to see if there are any blood clots.
• Catheter-guided venography: A small tube (catheter) is inserted into a vein, a special dye is injected, and an X-ray is taken to see where the blood clot is and how blocked the vein is.
• CTA (computerized tomography angiography): A CT scan takes detailed images of the veins.
• MRA (magnetic resonance angiography): Examination of the veins using an MRI scan.

What are the treatments for this?

ASVT is a condition that must be treated. Delaying treatment is not good. The main treatment method is `Thrombolysis`.

Treatment methods

• Thrombolysis (clot dissolving): This involves administering a clot-dissolving drug directly into the vein where the clot is located through a cannula-like tube (catheter).
• Thrombectomy (blood clot removal): Sometimes doctors physically remove this blood clot through a minor surgery.
• Blood thinners: After the blood clot is removed, you will be given blood thinners for several months to prevent blood clots from forming again.

Along with this treatment, the doctor will give you some other advice.

• Resting the hand until the symptoms subside.
• Holding the arm up is called ``arm elevations``.
• Referral to physical therapy.
• Wearing a special bandage-like covering (compression sleeve) on the arm.

In some cases, a small piece of muscle or a piece of the first rib that is blocking the vein is surgically removed to allow the vein to flow freely.

How is the situation after treatment?

This is the most important thing. If ASVT is diagnosed early and treatment is started early, the results are very successful. Studies have shown that there is a success rate of between 90% and 95%.

However, some people may develop a complication called `post-thrombotic syndrome (PTS).` This means that symptoms such as pain, heaviness, and swelling in the arm persist even after treatment. Therefore, it is very important to follow the doctor's instructions exactly.

Can this situation be prevented?

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

• Do not do strenuous exercises or work for a long time, and take breaks in between.
• Do stretches before and after exercising to stretch your arm muscles.
• Don't lift weights that your muscles can't handle.
• Try to use your non-dominant arm whenever possible.

When should I see a doctor?

See a doctor immediately at the first signs of ASVT (sudden swelling, pain, blueness of the hand). Also, if the following symptoms occur, consider it an emergency and go to a hospital's Emergency Treatment Unit (ETU) immediately.

• Chest pain
• Difficulty breathing (dyspnea)
• Numbness

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