Combined Jugular and Subclavian Vein Thrombosis Following Assisted Reproductive Technology: The Mystery Is out

In assisted reproductive technology (ART) high doses of human menopausal gonadotropins are used to induce controlled ovulation. This technology puts women at high risk of developing the ovarian hyperstimulation syndrome and thombotic events.

Objective: To discern the reason for predilection of combined jugular and subclavian following ART.

Methods: Women who developed combined jugular and subclavian vein thrombosis following assisted reproductive technology were included in the study. The thrombotic events were demonstrated by ultrasound Doppler or computerized tomography angiography. All women were interviewed and data obtained from outpatient clinic and hospital medical charts. Magnetic resonance imaging and complete thrombophilic profile work-up was performed in each woman. Open biopsy from the lesions was taken from one of the women for histological sections and immunohistochemical stains.

Results: Five women developed combined jugular and subclavian vein thrombosis following ART. They were found to harbor clusters of rudimentary branchial cysts filled with fluid at the time of ovarian hyperstimulation syndrome, 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: The predilection of combined jugular and subclavian vein thrombosis early in pregnancy is the result of mechanical compression mediated by rudimentary branchial cysts filled with fluid during ovarian hyperstimulation syndrome, particularly in subjects who are carriers of factor V Leiden.