Internal Jugular, Subclavian, and Axillary Deep Venous Thrombosis and the Risk of Pulmonary Embolism

Abstract

The objective of this study was to investigate the risk of acute internal jugular, subclavian, and axillary deep venous thrombosis (upper torso DVT [UTDVT]) and pulmonary embolism (PE) and the role of anticoagulation in a cohort of hospitalized patients. A 2-year retrospective review of hospitalized patients who underwent upper torso vein duplex scanning was performed. Patient demographics, underlying comorbidities, indication for scanning, diagnostic tests, intensive care unit stay, length of stay, presence of a central line (current or within the last 2 weeks), malignancy (current or former), hypercoaguable condition, postoperative state, renal failure, mortality, and use of anticoagulation were recorded. Univariate and multivariate analyses were performed to investigate significant risk factors for acute UTDVT. The impact of an acute UTDVT and use of anticoagulation on hospital length of stay, survival to 30 days and 1 year, and PE rate were calculated. One hundred eighty-nine patients were scanned. Sixty-three patients (33%) were found to have an acute UTDVT. The internal jugular vein was the most common site of thrombosis. The presence of a central venous catheter was the only factor found to be a significant risk factor for an acute UTDVT (p = .03). Five patients (7.9%) with an UTDVT had a PE documented by computed tomographic angiography-pulmonary arteriography, and all had an internal jugular thrombosis (four isolated and one combined with an axillary-subclavian thrombosis). No PE was fatal. Thirty-eight (60%) patients with an acute UTDVT were treated with therapeutic anticoagulation; the remainder were observed. All patients with a PE received anticoagulation. Hospital length of stay, 30-day mortality, and 12-month survival were no different for patients with and without an UTDVT (p = .7). The use of anticoagulation had no observable effect on survival in patients with UTDVT (p = .1). An acute internal jugular, subclavian, or axillary DVT is a relatively common finding in the hospitalized patient. Patients with a central line (current or within the previous 14 days) were at greatest risk, with an internal jugular vein thrombosis being the most common source. The inconsistent use of anticoagulation therapy for UTDVT was associated with a moderate risk of PE. A survival benefit for anticoagulation could not be documented.

The Incidence of Peripherally Inserted Central Catheter Symptomatic Pulmonary Embolism after Line Removal: A Retrospective Analysis

“…The overall incidence of PICC associated UEDV has been reported to be from 0 to 56% due to the heterogeneity of study conditions [26]. However, the overall incidence of PICC associated symptomatic venous thrombosis is most commonly reported at 2 to 7% [24].…”

“…Inconsistent use of anticoagulation treatment for UEDVT is associated with a moderate risk of PE [24]. In order to prevent thrombus progression and PE, anticoagulant treatment with low molecular weight heparin (LMWH) or unfractionated heparin (UFH) and vitamin K antagonists (VKA) is recommended [25].…”

Pulmonary embolism due to internal jugular vein thrombosis in a patient with non-small cell lung cancer receiving bevacizumab

“…However, internal jugular vein thrombosis is much less common and is generally caused by an indwelling venous catheter or otological infection [4]. In this article, we present a rare case of NSCLC complicated by PE due to internal jugular vein thrombosis associated with bevacizumab.…”

Pulmonary Embolism Due to Internal Jugular Vein Thrombosis without an Indwelling Catheter

“…The incidence of PE due to non-catheter-related thrombosis of the IJV is not fully known. A recent study reported that 87% of UTDVT patients were related to central catheters (9). The IJV was the most common site of the UTDVT (44%).…”

“…However, other sources must be considered when there is no evidence of thrombosis in the lower extremities. (8,9). The incidence of PE due to non-catheter-related thrombosis of the IJV is not fully known.…”