Upper Extremity D.V.T: A Review Article

Abstract

Upper extremity deep venous thrombosis (UEDVT) is also known as thrombosis of the axillary-subclavian vein, or Paget-Schroetter syndrome. It has primary and secondary varieties. Once considered rare, over the past decades U.E.D.V.T. has emerged as an increasingly important clinical entity. It makes up approximately 1-4% of all episodes of deep venous thrombosis (DVT) and carries a potential for considerable morbidity. Pulmonary embolism (PE) is present in up to one third of patients. Primary UEDVT is still a relatively infrequent disorder of predominantly young, otherwise healthy people who participate in repetitive upper extremity activity. From an epidemiologic perspective, the general incidence of UEDVT remains low (approximately 2/100 000 persons per year), even though it is the most common vascular condition among athletes. Although early clinical recognition of UEDVT is important, diagnosis can be difficult due to its indeterminate cause and indistinct pathophysiology. PRIMARY (idiopathic) UEDVT is rare with controversial pathogenesis and treatment. KEY WORDS; UEDVT, DVT, PE, LEDVT, SVC REVIEW OF LITERATURE: Symptoms of UEDVT are nonspecific, ranging in severity, and may be position dependent. Occasionally, patients may be entirely asymptomatic. Most commonly, however, patient complaints include initial "heaviness" in the affected arm, as well as a dull ache and pain in the neck, shoulder, and/or axilla of the involved limb. The differential diagnosis is complex because patients typically display compressive signs usually associated with thoracic outlet syndrome. Other more dramatic signs may include ecchymosis and non-edematous swelling of the shoulder, arm, and hand; functional impairment; discoloration and mottled skin; and, distention of the cutaneous veins of the involved upper extremity. Risk factors for UEDVT include central venous catheterization, strenuous upper extremity exercise or anatomic abnormalities causing venous compression, inherited thrombophilia, and acquired hypercoagulable states including pregnancy, oral contraceptive use, and cancer. Unexplained or recurrent UEDVT should prompt a search for inherited hypercoagulable states or underlying malignancy. In the present era the increased incidence is directly related to the increasing use of central venous catheters for chemotherapy, bone marrow transplantation, dialysis, and parenteral nutrition.. Pulmonary embolism (PE) is present in up to one third of patients with UEDVT (1). As high as 25 % of the patients with indwelling catheters can have UEDVT (2). Kabani et al (3) a study of 1,275 patients admitted to the surgical ICU over a 12-month period found that the incidence of UEDVT was higher than that of LEDVT (17% vs. 11%;