Prevalence of Thromboembolic Disease IncludingSuperior Vena Cava and Brachiocephalic Veins

Abstract

Thrombosis of the brachiocephalic veins or superior vena cava (SVC) is rare. This study was conducted to determine the prevalence and characteristics of thrombosis of brachiocephalic veins and SVC , and its association with symptomatic pulmonary embolism (PE). The prevalence of thrombosis involving the brachiocephalic veins and SVC was evaluated retrospectively at a university hospital during the 3-year period. Patients were identified by hospital records and review of computer-generated lists of of all venograms, contrast-enhanced chest computed tomography, and magnetic resonance angiograms of the upper extremity and SVC. Thrombosis of the brachiocephalic veins and SVC was diagnosed in 33 (0.03 %) of 100,942 patients of all ages [(32 of 70,751 adult patients >or= 20 years; 0.04%)]. Twenty-three (70%) patients initially had secondary thrombosis with multiple risk factors: associated with malignancy in 14 (42%) patients, chronic disorders in 13 (39%) patients, central venous lines (CVL) and peripheral venous lines (PVL) in 9 (27%) patients, and thrombophilia in 10 (38%) of 26 patients. Swelling of the arm, head, and neck was present in 32 (97%) patients. Symptomatic PE developed before thrombosis being treated in 12 (36%) patients. All patients except eight (three, thrombolytic; five, thrombectomy) received anticoagulant therapy. Thrombosis of the SVC and brachiocephalic veins is an uncommon but serious complication in patients with malignancy, chronic disorders, CVL, PVL, and thrombophilia. Because it is important clinical problem with frequent PE, the patients with appropriate clinical findings should be diagnosed early with imaging tests and treated with anticoagulant drugs.

The prevalence of upper extremity deep venous thrombosis

“…During the same period, LEDVT was diagnosed in 513 (0.72%) out of 70.751 adult patients, and seven of these (0.01%) had thrombosis of the SVC or brachiocephalic vein unaccompanied by UEDVT or LEDVT. [23] Ninety-one out of the 623 patients with DVT had UEDVT during this period, which accounted for 0.09% of the total number of patients admitted. Two patients were 17 years old.…”

“…Venography or MRA revealed that in 25 patients (27%), UEDVT extended to the brachiocephalic veins and in 11 patients (12%), it extended to the SVC (Figure 1). [23] The duration of symptoms before treatment was 9.0±9.5 days (between 1 and 30 days). The physical examination findings are shown in Table 2.…”

“…[18] Twelve patients (13%) with UEDVT extending to the brachiocephalic vein and/or the SVC had face and neck edema. [23] Thirty-two patients (35%) had symptomatic PE while four patients had fatal PE (one with cerebral hemorrhage after thrombolytic therapy; three with severe COPD and ARE). Pulmonary embolism occurred before the venous thrombosis was treated in all patients.…”

“…We also searched the hospital records and computergenerated lists for the presence of concomitant thrombosis of brachiocephalic veins (innominate) and/or SVC [23] along with coincidental symptomatic lower extremity deep venous thrombosis (LEDVT). An objective verification of the diagnosis was required for all patients, and all diagnoses of LEDVT were confirmed by CDU.…”

Septic cavernous sinus thrombosis secondary to a mycotic pseudoaneurysm of a cubital arteriovenous fistula

“…The manifestations included arm, head and neck swellings in 97% of the patients, which coincide with the findings in the patient being reported, and pulmonary embolism in 36% of the patients. No accounts of cavernous sinus thrombosis were observed [6]. Otten et al performed a study of nine patients with brachiocephalic vein occlusion and found that three of these patients had AV fistulas as their means of dialysis with no history of central lines.…”