Strength, courage and determination are qualities shared by many athletes, but sometimes a little extra is needed. Federico Pirani, a basketball player for Assigeco Piacenza, tells us how he faced and overcame an episode of upper extremity venous thromboembolism (VTE) and why recognizing symptoms early is so important for timely treatment. <\/p>\n
Federico is a professional basketball player, an athlete in excellent physical condition who had never experienced any significant health issues. In October 2025, he underwent what appeared to be a routine surgical procedure<\/strong> to repair a nasal septum fracture sustained during a sports injury<\/strong>. A couple of days later, he resumed training, but what initially seemed like a simple pain in his left arm <\/strong>turned out to be the beginning of an odyssey that today has finally come to an end with his return to competition. His journey was made even more challenging by the lack of dedicated pathways for athletes<\/strong>, ranging from the early recognition of symptoms to the selection of the most appropriate treatment strategies. <\/p>\n When a basketball player experiences arm pain, venous thrombosis is certainly not the first diagnosis that comes to mind. However, awareness of certain warning signs <\/strong>and risk factors <\/strong>that may predispose individuals to such events, including trauma, surgery, and long-haul air travel, can make a crucial difference.<\/p>\n \u201cAfter the surgery everything went well”, Federico explained. \u201cI was told that after two days I could resume training, which I did by starting with weightlifting. However, as soon as I got home, I began to feel discomfort in the biceps of my left arm<\/strong>. At first, I didn’t pay much attention to it, thinking it was simply muscle soreness. But the next day the discomfort was still there and never really went away<\/strong>.\u201d The first professional he contacted was the team’s physiotherapist, who also suspected a muscular problem and reassured him. Yet the discomfort persisted. <\/p>\n Two days later, Federico took a short flight <\/strong>to compete in another city, and everything seemed fine.<\/p>\n \u201cThe following morning I went to the basketball court and started shooting. After a few shots, the discomfort in my arm became increasingly intense. It felt as if there was an elastic band beneath my deltoid squeezing my arm. At one point I looked down and noticed that my entire arm had turned purple and was extremely swollen all the way down to my hand<\/strong>. We had no idea what it was, despite having the medical staff present. At one point we even considered the possibility of an insect bite.\u201d At that stage, Federico was taken to the emergency department, where a Doppler ultrasound scan and a CT scan revealed a deep vein thrombosis <\/strong>(DVT) involving the left axillary and subclavian veins. Anticoagulant treatment was started immediately, and further investigations identified a small pulmonary embolism. After two days, Federico was able to return home by train. He was referred to the FCSA Center in Sesto San Giovanni, where he began treatment with a direct oral anticoagulant (DOAC) and was advised to complete six months of therapy. The center would also provide ongoing follow-up care. <\/p>\n \u201cThey told me we had to wait for the clot to dissolve. Even if it dissolved earlier, I would still have to complete six months of treatment. At that point I had to accept that I wouldn’t be able to return to play during that season.\u201d<\/p>\n After three months, a follow-up Doppler ultrasound confirmed that the blood clot had resolved, which understandably came as a relief. However, investigations aimed at identifying predisposing conditions revealed the presence of thoracic outlet syndrome (TOS)<\/a>, one of the conditions most commonly associated with upper extremity venous thrombosis in certain category of athletes, including basketball, water polo and volleyball players, as well as athletes participating in other sports involving repetitive and intense arm movements. <\/p>\n The thoracic outlet<\/strong> is an anatomical region located at the upper part of the chest, near the neck, where nerves, arteries and veins pass through a very narrow space<\/strong> between the scalene muscles, the clavicle and the first rib. In some individuals, this anatomical passage is narrower than usual. Repetitive arm movements, especially those performed overhead, combined with increased muscle mass in the region, may compress nerves and blood vessels. This compression can cause symptoms such as sensory disturbances, arm weakness, venous or arterial thrombosis, a condition known as Thoracic Outlet Syndrome (TOS)<\/strong>. Veins are thinner and more susceptible to repetitive minor trauma than arteries. When this occurs repeatedly over time, particularly in high-level athletes, it may promote the formation of blood clots within the veins passing through this area, especially the subclavian vein. <\/p>\n Management options vary depending on the symptoms. Some patients experience exclusively neurological symptoms, while others develop venous or arterial complications. In all cases, a multidisciplinary evaluation<\/strong> involving thrombosis and hemostasis specialists, thoracic and\/or vascular surgeons, physiatrists and physiotherapists is essential to determine the most appropriate treatment. Therapeutic options range from physiotherapy to surgery. Whenever thrombosis is present, prompt antithrombotic treatment is necessary. <\/p>\n In Federico’s case, because he is a professional athlete whose work requires repetitive and intensive arm movements that could increase the risk of recurrent thrombosis, it was decided, after completion of the six-month anticoagulant course, to surgically correct the anatomical narrowing through a procedure performed at a highly specialized center.<\/p>\n Two additional months of treatment followed, ultimately leading to a complete recovery. And finally, Federico returned to play!<\/strong><\/p>\n \u201cI’ve already obtained medical clearance to compete again, and today my hematologist told me that I can stop taking anticoagulants,\u201d Federico explained. \u201cHowever, I was told by others that if I had undergone thrombolysis and surgery immediately, I probably wouldn’t have missed so many months of competition, which is very important for professional athletes.\u201d A legitimate question that deserves clarification.<\/p>\n A legitimate question that deserves clarification.<\/p>\n Anticoagulant therapy remains the gold standard treatment and should be started as soon as the diagnosis is made, provided there are no major contraindications. Its purpose is to prevent clot extension, embolization and to facilitate clot resolution. There is little debate on this point. <\/p>\n Endovascular clot removal procedures, with or without thrombolysis, represent additional treatment options that may be considered within two weeks of symptom onset in carefully selected patients and only at highly specialized centers. The goal of these procedures, which are not free from potential complications, is to accelerate clot resolution in patients with severe symptoms threatening limb function and to reduce the risk of post-thrombotic syndrome, a condition characterized by persistent pain and swelling. <\/p>\n Even when these procedures are considered, thoracic outlet decompression surgery, which may involve removal of the first rib, is generally performed only after the first three months of anticoagulant therapy have been completed (2).<\/p>\n Experience with these techniques and the available scientific evidence remain limited because the condition is rare. Consequently, current guidelines provide only limited recommendations based on the very low level of evidence currently available.<\/p>\n According to the 2021 European Society for Vascular Surgery (ESVS) Guidelines<\/a><\/em>, \u201cearly thrombus removal is not recommended for most patients with symptomatic upper extremity deep vein thrombosis. In selected young and active patients with very severe symptoms, thrombolysis may be considered within two weeks of symptom onset.\u201d (1)<\/p>\n Additional insight comes from the recently published experience of a major Italian-Swiss group<\/a> investigating the endovascular treatment of thoracic outlet syndrome (TOS)-related upper extremity venous thrombosis. (2) The investigators analyzed 41 patients (mean age 34 years), approximately half of whom were athletes, who underwent various endovascular thrombus-removal procedures, with or without thrombolysis. Overall outcomes were favorable; however, 39% of patients required a second procedure within the first two days. Two bleeding complications were reported, including one major hemorrhage. Nevertheless, the authors emphasize the limitations of the study, describing it as exploratory, and highlight the need for further research to better define the role of these treatment strategies. <\/p>\n Read also:<\/p>\n Interview with Agostino Abbagnale<\/a><\/p>\n Interview with Marco Mordente: How I Overcame a Pulmonary Embolism<\/a><\/p>\n Bibliography<\/strong><\/p>\n Strength, courage and determination are qualities shared by many athletes, but sometimes a little extra is needed. Federico Pirani, a basketball player for Assigeco Piacenza, tells us how he faced and overcame an episode of upper extremity venous thromboembolism (VTE) and why recognizing symptoms early is so important for timely treatment. Federico is a professional […]<\/p>\n","protected":false},"author":2,"featured_media":128,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"iawp_total_views":0,"footnotes":""},"categories":[8],"tags":[],"class_list":["post-129","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-thrombosis-and-sport"],"_links":{"self":[{"href":"https:\/\/anticoagulazione.it\/actions\/en\/wp-json\/wp\/v2\/posts\/129","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/anticoagulazione.it\/actions\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/anticoagulazione.it\/actions\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/anticoagulazione.it\/actions\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/anticoagulazione.it\/actions\/en\/wp-json\/wp\/v2\/comments?post=129"}],"version-history":[{"count":2,"href":"https:\/\/anticoagulazione.it\/actions\/en\/wp-json\/wp\/v2\/posts\/129\/revisions"}],"predecessor-version":[{"id":394,"href":"https:\/\/anticoagulazione.it\/actions\/en\/wp-json\/wp\/v2\/posts\/129\/revisions\/394"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/anticoagulazione.it\/actions\/en\/wp-json\/wp\/v2\/media\/128"}],"wp:attachment":[{"href":"https:\/\/anticoagulazione.it\/actions\/en\/wp-json\/wp\/v2\/media?parent=129"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/anticoagulazione.it\/actions\/en\/wp-json\/wp\/v2\/categories?post=129"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/anticoagulazione.it\/actions\/en\/wp-json\/wp\/v2\/tags?post=129"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}What is thoracic outlet syndrome?<\/h2>\n
What Can Be Done When Thoracic Outlet Syndrome Is Diagnosed?<\/h2>\n
Anticoagulation or Thrombolysis and\/or Thrombectomy?<\/h2>\n
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