Upper Extremity Deep Vein Thrombosis
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Contents |
Etiology
- primary (30%)
- idiopathic
- associated with thoracic outlet syndrome [3] (60% of primary UEDVT)
- secondary
- indwelling catheter-related (45%) [1,3] larger catheter confers higher risk
- 10% of patients with pacemakers [3]
- malignancy confers 8-fold increased risk [3]
- hypercoagulable state [3]
- obesity NOT risk factor
- hormone replacement therapy NOT risk factor
Epidemiology
- not rare [1]
- 4-10% of all DVT [3]
Pathology
- not benign [1]
- more likely to have cancer than patients with lower extremity DVT (38% vs 20%)
- less likely to present with acute pulmonary embolism than patients with lower extremity DVT (9% vs 29%)
Laboratory
Radiology
- non-invasive tests
-
- criteria is failure of venous lumen to fully collapse under gentle pressure from ultrasound transducer/ probe
- 82% sensitivity & specificity vs venography [2] for upper extremity DVT
Complications
- pulmonary emboli (~30%)
- postphlebitic syndrome less common than in patients with lower extremity DVT
Management
- treatment not standardized [3]
- anticoagulation: generally 3 months with target INR of 2.0-3.0, see deep vein thrombosis
- prognosis:
- recurrence lower than that for lower extremity DVT
- patients without catheters & without cancer with have lowest incidence of recurrence (0.5%) [1]
References
- Munoz FJ et al, Clinical outcome of patients with upper-extremity deep vein thrombosis: results from the RIETE Registry. Chest 2008, 133:143 PMID: [1]
- Journal Watch 22(5):36, 2002 Fraser DG et al, Diagnosis of lowe-limb deep vein thrombosis: a prospective blinded study of magnetic resonance direct thrombus imaging. Ann Intern Med 136:89, 2002 PMID: [2]
- Flinterman LE et al. Current perspective of venous thrombosis in the upper extremity. J Thromb Haemost 2008 Aug; 6:1262. PMID: [3]
- National Guideline Clearinghouse Suspected upper-extremity deep vein thrombosis. American College of Radiology (ACR) ngc-guideline: [4]
