The Paget-Schrœtter Syndrome (PSS) is a complication of the venous form of TOS. Blockage of the subclavian vein occurs due to clot formation. Although it is typically associated with exercise, patients can experience this whilst sleeping.

The subclavian vein is chronically traumatised by compression at the costo-clavicular space between the collarbone and the first rib. Some patients have intermittent symptoms if they have not developed the full blown blockage (known as McCleery’s syndrome). Occasionally, patients may have subclavian vein compression only on extremes of shoulder movement but without any symptoms.

As blood cannot drain back to the heart freely, the limb is swollen, uncomfortable and has a purplish discolouration. Untreated, the condition usually improves over a few days as blood finds its way through collateral channels. However, the improvement is variable and arm function may not be full. Treatment depends on the stage at which the patient presents, the severity and the final objective.

Best results are achieved with immediate diagnosis and intervention. The author’s preference is to attempt dissolution of the clot by chemical means through a catheter (known as catheter thrombolysis +/- thrombectomy). This is followed within a few days by early surgery to decompress the TOS and repair of the damaged vein if possible. This is a longer and more complicated procedure than treatment of neurological TOS alone. Unlike other parts of the body, stents are not usually recommended.

In patients with intermittent vein compression (without vein damage), surgery may be considered to prevent PSS. It is the author’s preference to perform this using a high-definition video-assisted transaxillary approach (through the armpit).

Some patients present after the acute phase when the problem is chronic arm swelling that affects their jobs and family life. Treatment is then focused on improving venous function. Following detailed discussions, the options that may be considered include decompression surgery, vein repair or bypass, or to treat this conservatively.

The purpose of treatment is to improve the quality of life and to maintain one’s occupation. This can be a difficult condition to treat. Recovery is variable depending on many factors and patients may require anticoagulation (blood thinners). Early treatment can be successful and some athletes have been able to return to professional sport. However, any delay reduces a good outcome.


Contacting Us


The Small Print

Mr Colin Chan
Consultant Vascular Surgeon
Wirral University Teaching Hospital
Wirral CH49 5PE

Mrs Louise Rule
Wirral University Teaching Hospital
Wirral CH49 5PE

(+44 151 604 7530)


Spire Wirral Hospital
Holmwood Drive
Wirral CH61 1AU

(+44 151 929 5181)

Spire Manchester Hospital
170 Barlow Moor Road
Manchester M20 2AF

(+44 161 447 6600)