Working Diagnosis:
Deep axillary vein thrombosis secondary to exertion (Paget­-Schroetter Syndrome) with possible exacerbation from a compression wrap.

Treatment:
Catheter directed thrombolysis with subsequent first rib excision.

Outcome:
She tolerated the procedures well and is on track to return to competition.

Author's Comments:
Compression banding is a common technique used in CrossFit competition. While no direct causality can be determined, banding may have contributed to the patient's thrombus.

Editor's Comments:
Paget-Schoetter syndrome describes an effort-induced thrombosis of the axillosubclavian vein. Thrombus formation in these patients is often associated with excessive upper extremity activity. (1) <br>These patients can be successfully treated with early diagnostic venography, thrombolysis, and paraclavicular thoracic outlet decompression. (2) <br>Repetitive positional compression of the axillary artery can also cause focal intimal hyperplasia, aneurysm formation, segmental dissection, and branch vessel aneurysms in overhead athletes. These lesions have a propensity toward thrombosis and distal embolism. Positional arteriography is used for diagnosis and these patients are treated surgically. (3)

References:
1. Keisler, Brian D. MD; Armsey, Thomas D. II MD. Paget­-Schroetter Syndrome in an Overhead Athlete. Current Sports Medicine Reports. 4(4). August 2005, 217­219. <br> <br>2. Spencer J. Melby, Suresh Vedantham, Vamsidhar R. Narra, George A. Paletta Jr, <br>Lynnette Khoo­Summers, Matt Driskill, Robert W. Thompson. Comprehensive surgical management of the competitive athlete with effort thrombosis of the subclavian vein <br>(Paget­-Schroetter syndrome), Journal of Vascular Surgery, 47.4, April 2008, 809­820. <br> <br>3. Yazan M. Duwayri, Valerie B. Emery, Matthew R. Driskill, Jeanne A. Earley, Rick W. Wright, George A. Paletta Jr, Robert W. Thompson. Positional compression of the <br>axillary artery causing upper extremity thrombosis and embolism in the elite overhead <br>throwing athlete, Journal of Vascular Surgery. 53.5, May 2011, 1329­1340. References

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