Semin intervent Radiol 2011; 28(1): 003-009
DOI: 10.1055/s-0031-1272975
© Thieme Medical Publishers

Endovascular Management of Acute Upper Extremity Deep Venous Thrombosis and the Use of Superior Vena Cava Filters

Joseph P. Koury1 , Charles T. Burke1
  • 1Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Further Information

Publication History

Publication Date:
22 March 2011 (online)

ABSTRACT

Upper extremity deep venous thrombosis (UEDVT), though less common than lower extremity DVT, is a significant problem with several possible etiologies. The incidence of UEDVT is on the rise, primarily from the increasing use of central venous access devices. However, there are other causes of UEDVT, including primary venous thrombosis (Paget-Schroetter syndrome) and hypercoagulable states associated with underlying malignancy. The morbidity and mortality associated with UEDVT is largely from pulmonary embolism and the postphlebitic syndrome. Nevertheless, many UEDVTs are asymptomatic or patients may present with nonspecific clinical symptoms; therefore, a high index of suspicion is often necessary to make a correct diagnosis. Currently, there is no standard treatment algorithm for UEDVT. Treatment options may range from systemic anticoagulation to surgical correction depending on the etiology of the thrombus, as well as the patient's associated comorbidities, life expectancy and expected quality of life following treatment.

REFERENCES

  • 1 Monreal M, Lafoz E, Ruiz J, Valls R, Alastrue A. Upper-extremity deep venous thrombosis and pulmonary embolism. A prospective study.  Chest. 1991;  99 (2) 280-283
  • 2 Coon W W, Willis III P W. Thrombosis of axillary and subclavian veins.  Arch Surg. 1967;  94 (5) 657-663
  • 3 Otten T R, Stein P D, Patel K C, Mustafa S, Silbergleit A. Thromboembolic disease involving the superior vena cava and brachiocephalic veins.  Chest. 2003;  123 (3) 809-812
  • 4 Owens C A, Bui J T, Knuttinen M G, Gaba R C, Carrillo T C. Pulmonary embolism from upper extremity deep vein thrombosis and the role of superior vena cava filters: a review of the literature.  J Vasc Interv Radiol. 2010;  21 (6) 779-787
  • 5 Joffe H V, Goldhaber S Z. Upper-extremity deep vein thrombosis.  Circulation. 2002;  106 (14) 1874-1880
  • 6 Haire W D. Catheter-induced upper extremity venous thrombosis. Available at: http://www.udtol.org Accessed July 19, 2010
  • 7 Girolami A, Prandoni P, Zanon E, Bagatella P, Girolami B. Venous thromboses of upper limbs are more frequently associated with occult cancer as compared with those of lower limbs.  Blood Coagul Fibrinolysis. 1999;  10 (8) 455-457
  • 8 Becker D M, Philbrick J T, Walker IV F B. Axillary and subclavian venous thrombosis. Prognosis and treatment.  Arch Intern Med. 1991;  151 (10) 1934-1943
  • 9 Prandoni P, Bernardi E. Upper extremity deep vein thrombosis.  Curr Opin Pulm Med. 1999;  5 (4) 222-226
  • 10 Machleder H I. The role of thrombolytic agents for acute subclavian vein thrombosis.  Semin Vasc Surg. 1992;  5 82
  • 11 Haire W D. Spontaneous upper extremity venous thrombosis (Paget-Schroetter syndrome). Available at: http://www.udtol.org Accessed July 19, 2010
  • 12 Spence L D, Gironta M G, Malde H M, Mickolick C T, Geisinger M A, Dolmatch B L. Acute upper extremity deep venous thrombosis: safety and effectiveness of superior vena caval filters.  Radiology. 1999;  210 (1) 53-58
  • 13 Joffe H V, Kucher N, Tapson V F, Goldhaber S Z. Deep Vein Thrombosis (DVT) FREE Steering Committee . Upper-extremity deep vein thrombosis: a prospective registry of 592 patients.  Circulation. 2004;  110 (12) 1605-1611
  • 14 Hingorani A, Ascher E, Lorenson E et al.. Upper extremity deep venous thrombosis and its impact on morbidity and mortality rates in a hospital-based population.  J Vasc Surg. 1997;  26 (5) 853-860
  • 15 Yucel E K, Oldan J D, Rybicki F J et al.. ACR Appropriateness Criteria suspected upper-extremity deep vein thrombosis. [Online publication]. Reston, VA: American College of Radiology (ACR); 2008. Available at: http://www.acr.org/secondarymainmenucategories/quality_safety/app_criteria/pdf/vascular/suspectedupperextremitydeepveinthrombosisdoc20.aspx Accessed October 17, 2010
  • 16 Martin E C, Koser M, Gordon D H. Venography in axillary-subclavian vein thrombosis.  Cardiovasc Radiol. 1979;  2 (4) 261-266
  • 17 Lee A Y, Ginsberg J S. Venous thrombosis of the upper extremities.  Curr Treat Options Cardiovasc Med. 2001;  3 (3) 207-214
  • 18 Donayre C E, White G H, Mehringer S M, Wilson S E. Pathogenesis determines late morbidity of axillosubclavian vein thrombosis.  Am J Surg. 1986;  152 (2) 179-184
  • 19 Haire W D, Lieberman R P, Edney J A et al.. Hickman catheter-induced thoracic vein thrombosis. Frequency and long-term sequelae in patients receiving high-dose chemotherapy and marrow transplantation.  Cancer. 1990;  66 (5) 900-908
  • 20 Moss J F, Wagman L D, Riihimaki D U, Terz J J. Central venous thrombosis related to the silastic Hickman-Broviac catheter in an oncologic population.  JPEN J Parenter Enteral Nutr. 1989;  13 (4) 397-400
  • 21 Smith V C, Hallett Jr J W. Subclavian vein thrombosis during prolonged catheterization for parenteral nutrition: early management and long-term follow-up.  South Med J. 1983;  76 (5) 603-606
  • 22 Mayo D J. Catheter-related thrombosis.  J Intraven Nurs. 2001;  24 S13-S22
  • 23 Lokich J J, Bothe Jr A, Benotti P, Moore C. Complications and management of implanted venous access catheters.  J Clin Oncol. 1985;  3 (5) 710-717
  • 24 Swinton Jr N W, Edgett Jr J W, Hall R J. Primary subclavian-axillary vein thrombosis.  Circulation. 1968;  38 (4) 737-745
  • 25 Hicken G J, Ameli F M. Management of subclavian-axillary vein thrombosis: a review.  Can J Surg. 1998;  41 (1) 13-25
  • 26 Kandarpa K, Aruny J. Handbook of Interventional Radiologic Procedures. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2002
  • 27 Fraschini G, Jadeja J, Lawson M, Holmes F A, Carrasco H C, Wallace S. Local infusion of urokinase for the lysis of thrombosis associated with permanent central venous catheters in cancer patients.  J Clin Oncol. 1987;  5 (4) 672-678
  • 28 Chang R, Horne III M K, Mayo D J, Doppman J L. Pulse-spray treatment of subclavian and jugular venous thrombi with recombinant tissue plasminogen activator.  J Vasc Interv Radiol. 1996;  7 (6) 845-851
  • 29 Mewissen M W, Seabrook G R, Meissner M H, Cynamon J, Labropoulos N, Haughton S H. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry.  Radiology. 1999;  211 (1) 39-49
  • 30 O'Sullivan G J, Lohan D G, Gough N, Cronin C G, Kee S T. Pharmacomechanical thrombectomy of acute deep vein thrombosis with the Trellis-8 isolated thrombolysis catheter.  J Vasc Interv Radiol. 2007;  18 (6) 715-724
  • 31 Arko F R, Cipriano P, Lee E, Filis K A, Zarins C K, Fogarty T J. Treatment of axillosubclavian vein thrombosis: a novel technique for rapid removal of clot using low-dose thrombolysis.  J Endovasc Ther. 2003;  10 (4) 733-738
  • 32 Hilleman D E, Razavi M K. Clinical and economic evaluation of the Trellis-8 infusion catheter for deep vein thrombosis.  J Vasc Interv Radiol. 2008;  19 (3) 377-383
  • 33 Pais S O, De Orchis D F, Mirvis S E. Superior vena caval placement of a Kimray-Greenfield filter.  Radiology. 1987;  165 (2) 385-386
  • 34 Usoh F, Hingorani A, Ascher E et al.. Long-term follow-up for superior vena cava filter placement.  Ann Vasc Surg. 2009;  23 (3) 350-354
  • 35 Ascher E, Hingorani A, Tsemekhin B, Yorkovich W, Gunduz Y. Lessons learned from a 6-year clinical experience with superior vena cava Greenfield filters.  J Vasc Surg. 2000;  32 (5) 881-887
  • 36 Kaufman J A, Thomas J W, Geller S C, Rivitz S M, Waltman A C. Guide-wire entrapment by inferior vena caval filters: in vitro evaluation.  Radiology. 1996;  198 (1) 71-76

Joseph P KouryM.D. 

Department of Radiology, University of North Carolina at Chapel Hill

CB# 7510, Chapel Hill, NC 27599

Email: jpkoury@gmail.com