title: The importance of the costoclavicular space in upper limb primary deep vein thrombosis, a study with magnetic resonance imaging (MRI) technique enhanced by a blood pool agent.
abstract: BACKGROUND
  Primary upper extremity deep vein thrombosis (UEDVT) can be divided into idiopathic and effort thrombosis. Anatomical factors probably play an important role in effort thrombosis, whereas the cause remains mostly unknown in idiopathic thrombosis.
  
  
  OBJECTIVE
  The primary objective of this study was to examine the anatomy of the subclavian region and evaluate how these factors contribute to primary UEDVT. The secondary objective was to investigate if venous compression correlates with post thrombotic syndrome (PTS).
  
  
  METHODS
  Fifteen patients and 15 controls were enrolled in the study. The subclavian region (the costoclavicular distance and vessel area) was examined by MRI enhanced by a blood-pool contrast agent (Vasovist). The MRI was performed in two arm positions: alongside and elevated. PTS and disability were quantified with the modified Villalta score and the Disability of the Arm, Shoulder and Hand (DASH) test.
  
  
  RESULTS
  The costoclavicular distance was significantly narrower in the UEDVT patients with the arms alongside the body but there was a significant difference only in the left arm with the arms elevated. Area of the subclavian vein: When comparing the patients non-thrombotic arm with the controls, there was a significant difference only when the arms in the supine position. Disability: There was a high correlation between DASH, Villalta and VAS but no correlation between the MRI measurement and patient's symptoms or the Villalta Score.
  
  
  CONCLUSIONS
  Our results suggest that primary UEDVT is dependent on the subclavian anatomy and area of vena subclavia.
authors.affiliation: Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden. Electronic address: thomas.arnhjort@telia.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Arnhjort
authors.affiliation: Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Nordberg
authors.affiliation: Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Delle
authors.affiliation: Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
authors.forename: Carl-Johan
authors.initials: CJ
authors.lastname: Borgis
authors.affiliation: Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Rosfors
authors.affiliation: Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
authors.forename: Gerd
authors.initials: G
authors.lastname: Lärfars
mesh_terms: D000328:Adult; D000368:Aged; D059925:Anatomic Landmarks / Q000033:anatomy & histology*; D016022:Case-Control Studies; D002968:Clavicle / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D054070:Postthrombotic Syndrome / Q000175:diagnosis*; D012272:Ribs / Q000033:anatomy & histology*; D013350:Subclavian Vein / Q000033:anatomy & histology*; D034941:Upper Extremity; D020246:Venous Thrombosis / Q000209:etiology*
keywords: Arm; Primary; Subclavian vein; Thrombosis