Upper extremity deep vein thrombosis: pathogenesis and treatment

Abstract

Upper extremity deep vein thrombosis (UEDVT) may be the first manifestation of venous thoracic outlet syndrome (VTOS). It primarily affects young, physically active people. The clinical findings depend on the degree of obstruction of the subclavian vein. Correct diagnosis-aided by various imaging modalities-as well as rapid initiation of local thrombolytic therapy, surgical decompression of the thoracic outlet (when indications are present), and the immediate initiation of anticoagulation therapy aim at successfully restoring the patient's quality of life.

Subclavian Effort and Upper Limb Thrombosis – a Lesson Learned

“…It is estimated that venous thromboembolic diseases annually manifest in approximately 200-300 in 100,000 persons. Onethird of these patients presents a pulmonary embolism (PE), while two-thirds are diagnosed with deep vein thrombosis (DVT) [6].…”

“…TOS represents the sum of clinical symptoms, regardless of the cause of the compression of the nerves and vessels of the upper limb, starting from the level of the neck down to the axillary fossa. TOS occurs in approximately 10 in 100,000 people [6]. Furthermore, venous TOS affects 3-5 % of patients and is diagnosed more often in men than in women, occurs mostly in young people, and is usually localised in the dominant arm [8].…”

“…As a diagnostic test, it is used in doubtful cases of compression and planned venous reconstructions. However, it still remains the "gold standard" for venous pathology evaluation and plays a particularly important role in the intraoperative assessment of blood flow through the subclavian vein, both before and after reconstruction or decompression surgery [6].…”

“…The Department of Vascular Surgery in Poznan has been performing 1 st rib removal surgery for over 30 years [6]. According to the authors, the basic principles of UEDVT treatment include rapid restoration of normal blood flow using anticoagulant prophylaxis, inhibition of the growth of thrombus and the surrounding inflammatory process, and restoration of the original limb function.…”