Interventional Therapy for Upper Extremity Deep Vein Thrombosis

Abstract

Approximately 10% of all deep vein thromboses occur in the upper extremity, and that number is increasing due to the use of peripherally inserted central catheters. Sequelae of upper extremity deep vein thrombosis (UEDVT) are similar to those for lower extremity deep vein thrombosis (LEDVT) and include postthrombotic syndrome and pulmonary embolism. In addition to systemic anticoagulation, there are multiple interventional treatment options for UEDVT with the potential to reduce the incidence of these sequelae. To date, there have been no randomized trials to define the optimal management strategy for patients presenting with UEDVT, so many conclusions are drawn from smaller, single-center studies or from LEDVT research. In this article, the authors describe the evidence for the currently available treatment options and an approach to a patient with acute UEDVT.

Single-Session Treatment of Upper Extremity Deep Venous Thrombosis and Central Venous Catheter Malfunction Using the ClotTriever System

“…The incidence of UEDVT due to CVC is reported to occur in six out of 10,000 hospitalizations, while patients with malignancy have a higher prevalence of 3.8% at 12 months [ 2 ]. Serious sequelae of UEDVT are similar to that of lower extremity DVT, including post-thrombotic syndrome and life-threatening PE [ 3 ]. Although the incidence of PE is considered to be lower with UEDVT than with lower extremity DVT (LEDVT), a recent study found the incidence of PE to be as high as 15% in ICU patients with UEDVT compared to 8% associated with LEDVT [ 4 ].…”

“…The goals of managing catheter-associated UEDVT include alleviation of symptoms, prevention of embolization, and maintenance of continuous intravenous access. In the absence of contraindications, systemic anticoagulation is recommended for LEDVT, with low-molecular-weight heparin being the preferred choice for patients with malignancy [ 3 ]. The American College of Chest Physicians guidelines also recommends anticoagulation over invasive management for UEDVT, with thrombolysis considered in patients with severe progressive symptoms, thrombus extending from subclavian to axillary vein, symptoms < 14 days, life expectancy > one year, and low risk of bleeding [ 5 ].…”

Inferior Vena Cava Filters—Current Role and Controversies

“…However, current data from experienced centers are promising, with good technical and clinical success even in high-risk patients. [45][46][47] In a systematic review on 21 publications and 209 SVC filter placements by Owens et al, the overall complication rate was only 3.8% with major complications that included cardiac tamponade, aortic perforation, and recurrent pneumothorax. 46…”

Upper extremity deep vein thrombosis: pathogenesis and treatment

“…Upper extremity deep vein thrombosis (UEDVT) accounts for approximately 4-10% of all cases of DVT [1,2]. Depending on the etiology, upper extremity DVT can be classified as either primary or secondary [3][4][5][6].…”

“…Most often, these authors perform a reconstruction of the affected vein with an autologous venous patch or a bovine pericardial patch. In the case of vessel obstruction, the occluded fragment of the subclavian vein is replaced by a cryopreserved femoral vein [2,5,27]. In the case of a venous graft, a peripheral arteriovenous fistula is necessary [27].…”