Thankfully, Heil et al. have now addressed in their work a clinical picture that frequently occurs in everyday clinical practice yet has a therapy that raises many questions, which are often insufficiently answered by reliable data (1). In addition, an important causal complex should be pointed out here.

Especially for younger patients, the compression syndromes of the upper thoracic outlet (the so-called thoracic outlet syndrome [TOS]) may give rise not only to lesions of the arterial tract but also to compression and damage of the subclavian or axillary vein. This may have a constitutional basis (compression of the anterior scalene muscle, presence of a cervical rib) or be due to excessive physical stress (bodybuilding, effort-induced thrombosis) in terms of a Paget–von Schrötter disease. In addition to anticoagulation and potentially recanalization, elimination of the anatomical obstruction (for example, the cervical rib) also plays a role in therapy (2, 3).

DOI: 10.3238/arztebl.2017.0613a

Dr. med. Klaus Hertting

Krankenhaus Buchholz, Innere Abteilung, Sektion Kardiologie und Angiologie, Germany

klaus.hertting@krankenhaus-buchholz.de

Conflict of interest statement

The author declares that no conflict of interest exists.

1.
Heil J, Miesbach W, Vogl T, Bechstein WO, Reinisch A: Deep vein thrombosis of the upper extremity—a systematic review. Dtsch Arztebl Int 2017; 114: 244–9 VOLLTEXT
2.
van den Houten MM, van Grinsven R, Pouwels S, Yo LS, van Sambeek MR, Teijink JA: Treatment of upper-extremity outflow thrombosis. Phlebology 2016; 31(Suppl 1): 28–33.
3.
Vazquez FJ, Paulin P, Poodts D, Gándara E: Preferred management of primary deep arm vein thrombosis. Eur J Vasc Endovasc Surg. 2017; 53: 744–51.
1.Heil J, Miesbach W, Vogl T, Bechstein WO, Reinisch A: Deep vein thrombosis of the upper extremity—a systematic review. Dtsch Arztebl Int 2017; 114: 244–9 VOLLTEXT
2.van den Houten MM, van Grinsven R, Pouwels S, Yo LS, van Sambeek MR, Teijink JA: Treatment of upper-extremity outflow thrombosis. Phlebology 2016; 31(Suppl 1): 28–33.
3.Vazquez FJ, Paulin P, Poodts D, Gándara E: Preferred management of primary deep arm vein thrombosis. Eur J Vasc Endovasc Surg. 2017; 53: 744–51.

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