Upper Extremity Deep Venous Thrombosis

Abstract

Upper extremity deep venous thrombosis (UEDVT) makes up approximately 1-4% of all episodes of deep venous thrombosis (DVT). 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. Clinical presentations include arm, neck, and shoulder pain; edema; skin discoloration; tenderness; and venous distension. Because UEDVT is frequently asymptomatic until complications ensue, a high index of suspicion is required for patients with one or more risk factors for thrombosis. Pulmonary embolism and post-thrombotic syndrome are the most common sequelae of UEDVT. Early detection and treatment of UEDVT decrease complications, morbidity, and mortality. Compressive ultrasonography is an effective and economical means of confirming the clinical diagnosis in most patients. Traditional anticoagulant therapy of UEDVT is giving way to a multimodal approach involving transcatheter thrombolytic therapy followed by a minimum of 3 months of warfarin sodium anticoagulant therapy, venous decompression as needed, and balloon angioplasty with stenting for treatment of residual stricture. Low-dose anticoagulant therapy can safely and effectively mitigate the increased risk of UEDVT associated with the use of central venous catheters.

Primary upper‐extremity deep vein thrombosis: High prevalence of thrombophilic defects

“…Although, in the earlier reports PE was thought to be almost nonexistent, it has become increasingly prevalent. In a revision of nine studies (406 patients) with UEDVT, PE was detected in 52 (12.8%) and showed the highest risk in patients with catheter-related UEDVT [29]. However, most of these studies assessed for patients with symptomatic PE.…”

Venous Obstruction in Asymptomatic Patients Undergoing First Implantation or Revision of a Cardiac Pacemaker or Implantable Cardioverter-Defibrillator: A Retrospective Single Center Analysis

“…Some authors recommend venography only in cases with clinically detectable signs of obstruction [16]. However, the development of often clinically inapparent collaterals may disguise even complete occlusion of the upper extremity veins [17]. Therefore, others authors advocate performing contrast venography in patients at risk of developing venous obstruction, e. g. in patients with a history of previous pacemaker implantation.…”

Trombose venosa da veia subclávia após fratura de clavícula: relato de caso

“…Effort Syndrome (Paget-Schroetter) was described at that time. This syndrome occurs as a result of repetitive effort in which demand is placed on the upper limb in positions of extreme abduction and lateral rotation, resulting in endothelial damage with the formation of a blood clot (9,10,14) . Deep vein thrombosis of the upper limb can be of idiopathic cause, and is generally associated with neoplasms.…”

“…Recent studies show complications like pulmonary thromboembolism (8-36%), post-anticoagulation recurrence (2-15%) and post-thrombotic syndrome (36-50%) (10,17,18) . Acute treatment of deep vein thrombosis of the upper limb includes raising the limb, analgesia and therapeutic doses of anticoagulant medication with low-molecular-weight or unfractionated heparin, followed by a period of three months of warfarin (10,17) . Oral or systemic thrombolysis with urokinase and streptokinase has been used with good results.…”

“…The most common injury mechanism is falling onto the palm of the hand, or onto a point on the shoulder, or direct or indirect traumas associated with contact sports (1,3,8) . Deep vein thrombosis of the upper limbs involving the subclavian and/or axillary vein is rare compared with deep vein thrombosis of the lower limbs, constituting 1-4% of deep vein thromboses of the limbs (9,10) . Few cases are cited in the orthopedic literature (11,12) .…”