Intravascular ultrasound-guided mechanical thrombectomy for venous thoracic outlet syndrome presenting as Paget-Schroetter syndrome: a case report

Abstract

Paget-Schroetter syndrome is an uncommon but important manifestation of venous thoracic outlet syndrome, typically affecting young or physically active individuals and presenting with acute upper extremity swelling and pain due to effort-related subclavian vein thrombosis. Delayed recognition may result in persistent venous obstruction, recurrent symptoms, and long-term functional morbidity. We present the case of an otherwise healthy, physically active middle-aged male who developed acute right upper extremity swelling and pain secondary to extensive subclavian and axillary vein thrombosis. Initial duplex imaging demonstrated acute deep venous thrombosis involving the subclavian, axillary, and brachial veins. Despite anticoagulation and catheter-directed thrombolysis, the patient experienced persistent venous hypertension. He subsequently underwent intravascular ultrasound (IVUS)-guided mechanical thrombectomy using the RevCore and ClotTriever systems, with restoration of venous patency and confirmation of persistent subclavian vein compression at the thoracic outlet. The patient experienced rapid symptomatic improvement and later underwent definitive thoracic outlet decompression with first rib resection and scalenectomy two months later, without reported complications. This case highlights the importance of recognizing Paget-Schroetter syndrome as a compression-related upper extremity disorder, the value of intravascular ultrasound in defining the underlying anatomic lesion, and the role of mechanical thrombectomy followed by definitive decompression in management.