Diagnostic and Therapeutic Management of Upper Extremity Deep Vein Thrombosis

Abstract

<jats:p>Upper extremity deep vein thrombosis (UEDVT) accounts for 5% of all deep vein thromboses (DVTs). UEDVT may be complicated by post thrombotic syndrome and pulmonary embolism, and early recognition and prompt start of anticoagulant treatment are key. Primary UEDVT, also known as Paget-von Schrötter syndrome, is associated with repeated or sudden physical activity of the upper arm and venous outflow obstruction due to anatomical variations. Secondary UEDVT is often associated with malignancy or use of intravenous devices, such as central venous catheters or pacemaker leads. Although the diagnosis and treatment of UEDVT have many similarities with DVT of the lower extremities, knowledge of specific aspects regarding UEDVT is important to guide optimal management. In this review, we will discuss the epidemiology, diagnosis, and treatment of UEDVT based on the current literature.</jats:p>

Direct oral anticoagulants for unusual‐site venous thromboembolism

“…UEDVT can be classified as primary (~25% of cases) or secondary (~75%), based on the pathophysiology 22 . Primary UEDVT refers to effort‐related thrombosis (Paget‐von Schrötter syndrome), thoracic outlet syndrome, and unprovoked thrombotic events 59 . The most common risk factors in secondary UEDVT are malignancy (22%‐64%) and central venous catheters (CVC) (10%‐93%) 59 .…”

“…Primary UEDVT refers to effort‐related thrombosis (Paget‐von Schrötter syndrome), thoracic outlet syndrome, and unprovoked thrombotic events 59 . The most common risk factors in secondary UEDVT are malignancy (22%‐64%) and central venous catheters (CVC) (10%‐93%) 59 . Other risk factors include implantable pacemakers, recent surgery or trauma, and thrombophilia.…”

“…Upper extremity deep vein thrombosis (UEDVT) includes thrombosis of the axillary, subclavian, internal jugular, or brachiocephalic veins (proximal veins) and thrombosis of the brachial, radial, or ulnar veins (distal veins) and represents around 5%-10% of all DVTs. 59,60 UEDVT can be classified as primary (~25% of cases) or secondary (~75%), based on the pathophysiology. 22 Primary UEDVT refers to effort-related thrombosis (Paget-von Schrötter syndrome), thoracic outlet syndrome, and unprovoked thrombotic events.…”

“…59 The most common risk factors in secondary UEDVT are malignancy (22%-64%) and central venous catheters (CVC) (10%-93%). 59 Other risk factors include implantable pacemakers, recent surgery or trauma, and thrombophilia. Among the possible complications, PE and postthrombotic syndrome (PTS) were less frequently reported in patients with UEDVT compared to those with lower extremity DVT (LEDVT).…”

Detection of upper extremity deep vein thrombosis by magnetic resonance non‐contrast thrombus imaging

“…Furthermore, because venography is not routinely performed anymore, radiologists have limited experience evaluating UEDVT by this method 4,5 . Computed tomography (CT) venography is often used as an alternative, although studies regarding its diagnostic accuracy in UEDVT are scarce 6 …”