TAMPA — The chances seemed remote.
But when Lightning captain Steven Stamkos was diagnosed late last week with a blood clot near his right collarbone — the result of a rare vascular condition — Lightning had indeed struck twice.
Stamkos, 26, had successful surgery Monday at Tampa General Hospital for a vascular thoracic outlet syndrome called effort thrombosis. His surgery came almost seven months to the day after backup goaltender Andrei Vasilevskiy had surgery to treat the same condition, also known as Paget-Schroetter Syndrome.
A nationally recognized expert in effort thrombosis, however, wasn’t shocked the teammates were diagnosed with the same vascular condition within a seven-month span.
“Yes, it is unusual that there are two players from the same team, but I’m not that surprised,” said Julie Freischlag, Dean of the School of Medicine at UC Davis in Sacramento, California, and a former chair of the surgery department and surgeon-in-chief at Johns Hopkins.
“We frequently see it in young people that do construction work and other activities. We think the vein gets chronically irritated over time and then one day, it clots. That’s when you get the swelling and thrombosis in the arm.”
Karl Illig, director of vascular surgery at the University of South Florida, performed the two-hour surgery on Stamkos to remove the star center’s upper right rib. Stamkos is expected to fully recover, but will miss 1-3 months.
“Everything went as expected for Steven today,” Illig said after the procedure. “We plan to re-evaluate him in about two weeks and we should know more about his prognosis at that time.”
Illig also performed the Sept. 3 surgery on Vasilevskiy, who was cleared to return to practice in late October.
“It’s absolutely bad luck and it certainly is unusual for this to happen twice,” Illig said. “I believe the culprit in this process in general is muscular development. The common path is these players tend to be very muscular and very athletic, and that’s the risk factor for this condition.
“In a way, Vasy’s experience may have helped Steven because he might not have even noticed this had it not been for his teammate. It’s a very unusual coincidence.”
Effort thrombosis often results from repetitive, strenuous arm movement that damages a large vein between the collarbone and the top of the rib cage. The vein is constricted, causing blood to stagnate and creating enough irritation in the vein walls for a clot to form.
“It’s not dangerous if it’s appropriately diagnosed,” Freischlag said. “You see the swollen arm and you get an ultrasound to show the clot. You can put the patient on blood thinners, but we think you have to address the cause — the muscle in the first rib pushing on the vein. So you take out the rib and muscle.
“Dr. Illig is a friend of mine and he’s very good at this. Once you get the rib and muscle out, you treat the patient with blood thinners for a couple of months and make sure the vein is open. I’d say 98 percent of patients go back to their professional careers.”
The condition has usually been associated with men, but Freischlag said she is seeing more women afflicted with effort thrombosis. The condition is different, and far less dangerous, than blood clots in legs, which have a great risk of traveling to the lungs.
“People who get clots in their legs are usually older,” she said. “People on airplanes, people who sit for long periods of time. With effort thrombosis, usually the patients are active and usually they’re young. They’re construction workers or athletes and it’s the compressions from the outside ... very, very different. The risk of drawing a clot to your lungs from your legs is almost three or four times more likely than from your arms.”
Vasilevskiy, 21, has started 19 games for the Lightning this season and appeared stunned by the news about Stamkos.
“It’s unbelievable — same team, same thing, same year, it’s unbelievable,” Vasilevskiy said on Monday. “It’s a big loss for us, but I hope he will be fine after one month. We will see.”
Blood clots are not uncommon in professional athletics.
In recent years, NBA players Chris Bosh of the Miami Heat and Mirza Teletovic of the New Jersey Nets were diagnosed with clots that traveled to their lungs. Tennis superstar Serena Williams was forced to miss almost a year after suffering a pulmonary embolism following her Wimbledon title in 2010.
In the NHL, former Florida Panthers goaltender Tomas Vokoun, former Pittsburgh Penguins forward Pascal Dupuis and former Chicago Blackhawks defenseman Kimmo Timonen were diagnosed with blood clots in their legs. Vokoun and Dupuis retired early because of the danger.
Effort thrombosis is far more rare and used to be treated primarily with blood thinners before surgery became the remedy of choice in the medical community.
“There’s probably only about six to 15 people in the whole country who really pay attention to this condition,” said Illig, who characterized the health issues of Stamkos and Vasilevskiy as “virtually identical.”
“All too often, even in 2016, it gets missed and people get sent home from the emergency room with blood thinners alone,” he said. “We treat a lot of people like this and it’s an honor to treat people like Steven Stamkos. His spirits are very good and I have been impressed by how mature Steven has been. He has approached this in a very intelligent way. He’s never been down, and I’m hoping that because Vasy did so well, that’s giving him a little boost.”
Tribune reporter Erik Erlendsson contributed to this report.