Repeated local thrombolysis in a patient with axillary and subclavian vein injury and thrombosis

Authors: S. Šárník;  I. Hofírek
Authors‘ workplace: I. interní kardio‑angiologická klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MU Dr. Jiří Vítovec, CSc., FESC
Published in: Vnitř Lék 2009; 55(11): 1102-1104
Category: Case Reports


Deep vein thrombosis (DVT) is a disorder with blood clot (thrombus) formation in deep veins. DVT of upper extremities (UE) is rare but serious, bearing in mind its possible complications, disease. UE DVT treatment involves subcutaneous injections of low molecular weight heparins and subsequent switch to oral anticoagulation or thrombolysis; thrombolysis by intravenous administration of a thrombolytic agent is used only if indicated (subclavian vein thrombosis). A case of a professional sportswoman is presented, who was treated for venous thrombosis of subclavian and axillary veins using local thrombolysis. Thrombosis emerged suddenly after a basketball match, during which oedema of the right arm occurred subsequent to the patient being hit with the ball to the armpit area. Venipuncture as well as all catheter repositionings were performed under the duplex ultrasound (DUS) surveillance. Proximal brachial vein was punctured and four French catheters were used to enter subclavian vein. For thrombolysis, 0.2– 0.6 mg/ hour alteplase (rt- PA) was used. Injury to axillary vein tunica intima was evident the following day after the subclavian and axillary thrombosis was dissolved completely, and thrombosis in the same area recurred immediately after stopping the thrombolytic infusion. Therefore, administration of a thrombolytic agent into the same area was re‑introduced and acetylsalicylic acid was added to the medication. This combined therapy resulted in recanalization of the arm as well as the axillary and subclavian areas. Thrombolysis was stopped on the 3rd day of treatment. The method can be used to manage deep vein thromboses of the upper arms even without X‑ray control. Local thrombolysis of deep vein thrombosis with ultrasound surveillance is, in indicated patients, a safe method even if a vein injury occurs.

Key words:
deep vein thrombosis –  local thrombolysis –  ultrasound surveillance –  re‑thrombosis –  recanalization


1. Puchmayer V, Roztočil K. Onemocnění žil. In: Puchmayer V, Roztočil K (eds). Praktická angiologie. Praha: Triton 2000: 115– 164.

2. Vítovec M, Pecháček V. Doporučení pro duplexní ultrazvukové vyšetření končetinových žil. Vnitř Lék 2009; 55: 136– 146.

3. Karetová D, Staněk F et al. Angiologie pro praxi. Praha: Maxdorf 2001.

4. Hofírek I, Penka M, Šárník S. Invazivní kontrolovaná léčba hluboké žilní trombózy. Vnitř Lék 2005; 51: 795– 801.

5. Ginsberg JS. Management of venous thromboembolism. N Engl J Med 1996; 335: 1816– 1828.

6. Spáčil J. Trombóza hlubokých žil. In: Klener P (ed). Vnitřní lékařství, sv. II., Kardiologie, Angiologie. Praha: Galén 2001: 338– 348.

7. Čepelák V. Ambulantní antikoagulační léčba. Doporučené postupy pro praktické lékaře. Praha: Česká lékařská společnost J. E. Purkyně 2002.

8. Elliot G. Thrombolytic therapy for venous thromboembolism. Curr Opin Hematol 1999; 6: 304– 308.

9. Treat SD, Smith PA, Wen DY. Deep vein thrombosis of the subclavian vein in a college volleyball player. Am J Sports Med 2004; 32: 529– 532.

10. Kurgan A, Abramowitz H, Shapiro J. Traumatic axillary and subclavian vein thrombosis after seat belt injury. J Vasc Nurs 1997; 15: 134– 135.

11. Zpráva z IX. Kongresu Evropské ortopedické a traumatologické společnosti (EFORT) –  Pokroky v profylaxi žilní trombózy. Medical Tribune 2008; 18: C8.

Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 11

2009 Issue 11

Most read in this issue

This topic is also in:

Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account