Pulmonary embolism secondary to venous thrombosis of the arm

Harley, Daniel P.; White, Rodney A.; Nelson, Ronald J.; Mehringer, C M

doi:10.1016/0002-9610(84)90093-x

Cited by 70 publications

(19 citation statements)

References 20 publications

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“…It is difficult to calculate if each UEDVT modality has a different PE incidence rate, but Hughes [10 ]reported only three cases of PE from his 320 patients. On the other hand, Harley et al [37 ]reported an incidence of PE in 10–12% of their patients.…”

Section: Treatment and Complicationsmentioning

confidence: 96%

Exercise-Induced Deep Vein Thrombosis of the Upper Extremity

Brandão¹,

Williams²,

Kahr³

et al. 2006

Acta Haematol

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Paget-Schroetter syndrome or effort-related upper extremity deep vein thrombosis is a rare condition that usually afflicts young healthy individuals, most commonly males. The cause is multifactorial but almost always involves extrinsic compression of the subclavian vein at the thoracic inlet, causing venous stenosis from repetitive trauma. The diagnosis of this condition may be difficult, and its delay may contribute to potential complications including thrombosis progression, pulmonary embolism, thrombosis recurrence, and post-thrombotic syndrome. Similarly, the best therapeutic option has not been established and in the lack of evidence-based guidelines, treatment may be extremely challenging especially in children, in whom long-term complications can be particularly disabling.

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Section: Treatment and Complicationsmentioning

confidence: 96%

Exercise-Induced Deep Vein Thrombosis of the Upper Extremity

Brandão¹,

Williams²,

Kahr³

et al. 2006

Acta Haematol

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“…However, many of these studies include both primary and secondary DVTs in their analysis. 7,[9][10][11][12][13][14][15][16] Furthermore, small sample size and PE rates based mostly on ventilation-perfusion (V/Q) scanning further limit their interpretation.…”

mentioning

confidence: 99%

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

et al. 2008

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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.

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“…The third patient of this group was submitted to catheter-guided fibrinolysis followed by first rib resection after she presented with major arm function impairment accompanied by TOS. The protocol for fibrinolysis that was utilized prior to surgery has been previously published [9]. Multisidehole infusion catheter containing urokinase (120,000–180,000 IU/h) was inserted, and success of thrombolysis was assessed by serial venograms at 6- to 12-hour intervals.…”

Section: Resultsmentioning

confidence: 99%

Exercise-Induced Deep Vein Thrombosis of the Upper Extremity

Brandão

Williams²,

Kahr³

et al. 2006

Acta Haematol

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Upper-extremity deep venous thrombosis (UEDVT) is an increasingly important clinical problem in children. These events are classified as primary or secondary, with the latter being the most common and usually associated with the presence of a central venous line. Among primary UEDVT, the so-called Paget-Schroetter syndrome, effort-related or exercise-induced upper-extremity thrombotic event represents an extremely rare finding that has never been described in a pediatric series. The objective of the second part of this two-part article is to report the first pediatric series in a group of adolescents with this condition from a single center, describing their clinical features, management, and outcome. A retrospective chart review of 6 patients seen between December 2003 and April 2005 was conducted, with a median follow-up of 9 months (range 2–17). Four females and two males, all Caucasian, were enrolled with a median age of 16 years (range 14–17). In all cases, strenuous exercise was present in the month preceding diagnosis and mild trauma was present in only one case (weight lifting). At presentation, all patients had objective swelling of the affected limb for a median of 4 days (range 2–14), and 4 patients had UEDVT of the dominant arm. Thrombophilia investigation revealed that 50% had a combined prothrombotic state at presentation, and all patients were/are being treated with anticoagulation for 6 months (low-molecular-weight heparin followed by warfarin). Continuation of the initial symptoms was present in all cases but one at the 3-month clinic follow-up (last case has yet to reach 3 months of follow-up), and residual moderate to severe postthrombotic syndrome was present in all 3 cases followed for more than 12 months. Of those 3 patients followed for more than 1 year, 2 patients recurred despite having complete resolution of the thrombus after 6 months of anticoagulation, and the third patient underwent surgery with clinical improvement. Adolescents with UEDVT treated only with anticoagulation seem to have a poor outcome.

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Pulmonary embolism secondary to venous thrombosis of the arm

Cited by 70 publications

References 20 publications

Exercise-Induced Deep Vein Thrombosis of the Upper Extremity

Exercise-Induced Deep Vein Thrombosis of the Upper Extremity

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

Exercise-Induced Deep Vein Thrombosis of the Upper Extremity

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