Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications.

BACKGROUND Little is known about the clinical, diagnostic, and prognostic aspects of upper-extremity deep vein thrombosis (UEDVT). OBJECTIVES To identify the clinical and laboratory parameters associated with this disease, to assess the diagnostic accuracy of ultrasonographic methods for its detection, and to establish the frequency of both early and late complications. PATIENTS AND METHODS After a careful history was taken, 58 consecutive patients with signs and symptoms that were clinically suggestive of UEDVT underwent the determination of antithrombin III and protein C and S levels and resistance to activated protein C and lupuslike anticoagulants. Compression ultrasonography, color flow Doppler imaging, and Doppler ultrasonography were performed prior to venography. Patients with confirmed UEDVT underwent objective tests to detect a pulmonary embolism and were followed up prospectively to record recurrent thromboembolic events and postthrombotic sequelae. RESULTS Findings from venography confirmed UEDVT in 27 patients (47%). Central venous catheters, thrombophilic states, and a previous leg vein thrombosis were statistically significantly associated with UEDVT. Sensitivity and specificity of compression ultrasonography (96% and 93.5%, respectively) and color flow Doppler imaging (100% and 93%, respectively) were comparable and better than those of Doppler ultrasonography (81% and 77%, respectively). Objective findings suggestive of a pulmonary embolism were recorded in 36% of the patients with UEDVT. After a mean follow-up of 2 years, 2 patients with UEDVT experienced recurrent thromboembolic events, and 4 had postthrombotic sequelae. CONCLUSIONS Symptomatic UEDVT is associated with central venous catheters, thrombophilic states, and a previous leg vein thrombosis. Both compression ultrasonography and color flow Doppler imaging are accurate methods for its detection. A pulmonary embolism is a common complication of the disease. Finally, this disorder may recur and may be followed by postthrombotic sequelae.

[1]  Paolo Prandoni,et al.  The Long-Term Clinical Course of Acute Deep Venous Thrombosis , 1996, Annals of Internal Medicine.

[2]  G. Hughes,et al.  The management of thrombosis in the antiphospholipid-antibody syndrome. , 1995, The New England journal of medicine.

[3]  M. Monreal,et al.  Pulmonary Embolism in Patients with Upper Extremity DVT Associated to Venous Central Lines - A Prospective Study , 1994, Thrombosis and Haemostasis.

[4]  H. Gralnick,et al.  Upper Extremity Impedance Plethysmography in Patients with Venous Access Devices , 1994, Thrombosis and Haemostasis.

[5]  B. Dahlbäck,et al.  Resistance to activated protein C as a basis for venous thrombosis. , 1994, The New England journal of medicine.

[6]  K. Moser,et al.  Frequent asymptomatic pulmonary embolism in patients with deep venous thrombosis. , 1994, JAMA.

[7]  B. Coppéré,et al.  Les thromboses veineuses profondes des membres supérieurs , 1994 .

[8]  P. Rasuli,et al.  Upper extremity deep venous thrombosis. Underdiagnosed and potentially lethal. , 1993, Chest.

[9]  B. Ramdani,et al.  Thromboses veineuses après cathétérisme de la veine sous-clavière pour hémodialyse , 1993 .

[10]  P. Kyrle,et al.  Hereditary deficiency of antithrombin III, protein C and protein S: prevalence in patients with a history of venous thrombosis and criteria for rational patient screening , 1992, Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis.

[11]  A. Alavi,et al.  Value of ventilation/perfusion scans versus perfusion scans alone in acute pulmonary embolism. , 1992, The American journal of cardiology.

[12]  M. Depairon,et al.  Assessment of acute and old deep venous thrombosis in upper extremity by venous strain gauge plethysmography. , 1992, VASA. Zeitschrift fur Gefasskrankheiten.

[13]  J. Philbrick,et al.  Axillary and subclavian venous thrombosis. Prognosis and treatment. , 1991, Archives of internal medicine.

[14]  W. Kincaid,et al.  Comparison of colour Doppler ultrasound with venography in the diagnosis of axillary and subclavian vein thrombosis. , 1991, The British journal of radiology.

[15]  H. Büller,et al.  A New Computerized Impedance Plethysmograph: Accuracy in the Detection of Proximal Deep-Vein Thrombosis in Symptomatic Outpatients , 1991, Thrombosis and Haemostasis.

[16]  M. Monreal,et al.  Upper-extremity deep venous thrombosis and pulmonary embolism. A prospective study. , 1991, Chest.

[17]  H. Büller,et al.  Deficiencies of coagulation-inhibiting and fibrinolytic proteins in outpatients with deep-vein thrombosis. , 1990, The New England journal of medicine.

[18]  M. Sampson,et al.  Upper extremity venous thrombosis diagnosed by duplex scanning. , 1990, American journal of surgery.

[19]  Color Doppler Sonographic Imaging in the Assessment of Upper Extremity Deep Venous Thrombosis , 1990 .

[20]  H. Büller,et al.  Diagnosis of deep-vein thrombosis using an objective Doppler method. , 1990 .

[21]  S. L. Hill,et al.  Subclavian vein thrombosis: a continuing challenge. , 1990, Surgery.

[22]  J. Polak,et al.  Axillary and subclavian venous thrombosis: follow-up evaluation with color Doppler flow US and venography. , 1990, Radiology.

[23]  P. Investigators,et al.  Value of the ventilation/perfusion scan in acute pulmonary embolism. Results of the prospective investigation of pulmonary embolism diagnosis (PIOPED). , 1990, JAMA.

[24]  P. Benotti,et al.  Very low doses of warfarin can prevent thrombosis in central venous catheters. A randomized prospective trial. , 1990, Annals of internal medicine.

[25]  P. V. Van Schil,et al.  Deep venous thrombosis of the upper extremity: case reports and review of the literature. , 1989, Acta chirurgica Belgica.

[26]  S. S. Hung,et al.  Deep vein thrombosis of the arm associated with malignancy , 1989, Cancer.

[27]  M. Kersten,et al.  Unexpected high prevalence of silent pulmonary embolism in patients with deep venous thrombosis. , 1989, Chest.

[28]  H. Büller,et al.  Detection of deep-vein thrombosis by real-time B-mode ultrasonography. , 1989, The New England journal of medicine.

[29]  F. Kainberger,et al.  Internal jugular and subclavian vein thrombosis caused by central venous catheters. Evaluation using Doppler blood flow imaging. , 1988, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[30]  D. Evans,et al.  Changing concepts of deep venous thrombosis of the upper extremity--report of a series and review of the literature. , 1988, Surgery.

[31]  J. Cronan,et al.  Occult pulmonary embolism: a common occurrence in deep venous thrombosis. , 1987, AJR. American journal of roentgenology.

[32]  S. Wilson,et al.  Pathogenesis determines late morbidity of axillosubclavian vein thrombosis. , 1986, American journal of surgery.

[33]  J. Weinreb,et al.  MRI evaluation of mediastinal and thoracic inlet venous obstruction. , 1986, AJR. American journal of roentgenology.

[34]  J. Bartholomew,et al.  PULMONARY THROMBOEMBOLIC DISEASE , 1985, Current problems in cardiology.

[35]  C. Mehringer,et al.  Pulmonary embolism secondary to venous thrombosis of the arm. , 1984, American journal of surgery.

[36]  J. Lokich,et al.  Subclavian vein thrombosis in patients treated with infusion chemotherapy for advanced malignancy , 1983, Cancer.

[37]  J. Glover,et al.  Local thrombolytic therapy for subclavian and axillary vein thrombosis. Treatment of the thoracic inlet syndrome. , 1983, Radiology.

[38]  J. Whalen,et al.  CT diagnosis of mediastinal and thoracic inlet venous obstruction. , 1983, AJR. American journal of roentgenology.

[39]  C. Zarins,et al.  Diagnosis of upper extremity deep venous thrombosis using noninvasive technique. , 1982, Surgery.

[40]  James G. Chandler,et al.  Axillary, subclavian, and brachiocephalic vein obstruction. , 1977, Surgery.

[41]  D. B. Roos.  Congenital anomalies associated with thoracic outlet syndrome. Anatomy, symptoms, diagnosis, and treatment. , 1976, American journal of surgery.

[42]  W. Loring,et al.  Venous thrombosis in the upper extremities as a complication of myocardial failure. , 1952, The American journal of medicine.