title: [Recurrent pulmonary embolism from left subclavian thrombosis: a case report].
abstract: A 38-year-old woman was admitted to our hospital because of pulmonary thromboembolism. Thrombolysis therapy resulted in initial improvement in symptoms and laboratory data. However, 4 months later, pulmonary thromboembolism recurred despite antiplatelet and anticoagulation therapy. Contrast venography and venous ultrasonography of both upper and lower extremities revealed subtotal occlusion and venous thrombosis of the left subclavian vein with collateral vessels, but no evidence of lower extremity venous thrombosis. She had no history of subclavian venous catheterization, neoplasm, hypercoagulability or other predisposing cause of thrombus formation. Operative ligation of the left subclavian vein was performed at the junction with the internal jugular vein. White thrombus was identified within the venous lumen. She was well without recurrent pulmonary thromboembolism or venous insufficiency for 10 months after the operation. Surgical interruption of the subclavian vein may be effective to prevent recurrent pulmonary thromboembolism in patients with recurrent pulmonary thromboembolism due to venous thrombosis of the upper extremity despite therapeutic anticoagulation.
authors.affiliation: Division of Cardiology, Miyazaki Cardiovascular Hospital.
authors.forename: J
authors.initials: J
authors.lastname: Kawagoe
authors.forename: M
authors.initials: M
authors.lastname: Takenaga
authors.forename: T
authors.initials: T
authors.lastname: Ishikawa
authors.forename: H
authors.initials: H
authors.lastname: Doi
authors.forename: J
authors.initials: J
authors.lastname: Matsuda
authors.forename: T
authors.initials: T
authors.lastname: Unoki
authors.forename: K
authors.initials: K
authors.lastname: Nakamura
authors.forename: T
authors.initials: T
authors.lastname: Onitsuka
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D011877:Radionuclide Imaging; D012008:Recurrence; D013350:Subclavian Vein / Q000000981:diagnostic imaging / Q000601:surgery; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications*; D014463:Ultrasonography