Combined jugular and subclavian vein thrombosis following assisted reproductive technology—new observation

ObjectiveTo study the predilection of jugular and subclavian vein thrombosis in patients going through assisted reproductive technology (ART). This technology puts women at high risk of developing the ovarian hyperstimulation syndrome (OHSS) and thrombotic events.DesignStudy cases.SettingLarge Academic Medical Center.Patient(s)Five women who developed jugular and subclavian vein thrombosis following ART were included in the study.Intervention(s)The deep vein thrombosis was demonstrated by ultrasound Doppler or computerized tomography angiography. All women were interviewed and data obtained from outpatient and hospital medical charts. Magnetic resonance imaging and complete thrombophilic profile workup was performed in each woman. Open biopsy from the lesions was taken from one of the women.Main Outcome Measure(s)Correlation between mechanical branchial cysts filled with fluid during OHSS and jugular and subclavian vein thrombosis.Result(s)Five women developed jugular and subclavian vein thrombosis following ART. They were found to harbor clusters of rudimentary branchial cysts filled with fluid at the time of OHSS, which compressed the jugular and subclavian veins at their junction at the base of the neck. Four patients (80%) were found to be carriers of factor V Leiden.Conclusion(s)Predilection of jugular and subclavian vein thrombosis early in pregnancy is the result of mechanical compression mediated by rudimentary branchial cysts filled with fluid during OHSS, particularly in subjects who are carriers of factor V Leiden.