Pulmonary embolus after treatment for subclavian-axillary vein thrombosis

Treatment of effort-induced subclavian-axillary vein thrombosis of the upper extremity is aimed at elimination of the chronic symptoms of the postphlebitic syndrome. Various treatments have been tried, with varied success. Recently, fibrinolytic therapy with streptokinase (Abbokinase) or urokinase (Kabikinase, Streptase) has gained popularity as a treatment option. In the case presented here, complete lysis of effort-induced subclavian-axillary vein thrombosis was achieved with the use of catheter-directed infusion of streptokinase. Subsequently, a pulmonary embolus developed, causing marked morbidity. It is likely that fibrinolytic therapy was directly responsible for this complication. The current literature does not support routine use of fibrinolytic agents in the treatment of effort-induced thrombi of the upper extremity, since these agents can cause significant morbidity. We conclude that fibrinolytic therapy should be reserved for life-threatening conditions, such as myocardial infarction, massive pulmonary emboli, and significant arterial occlusions.