Interventional Therapy for Upper Extremity Deep Vein Thrombosis

Abstract

Approximately 10% of all deep vein thromboses occur in the upper extremity, and that number is increasing due to the use of peripherally inserted central catheters. Sequelae of upper extremity deep vein thrombosis (UEDVT) are similar to those for lower extremity deep vein thrombosis (LEDVT) and include postthrombotic syndrome and pulmonary embolism. In addition to systemic anticoagulation, there are multiple interventional treatment options for UEDVT with the potential to reduce the incidence of these sequelae. To date, there have been no randomized trials to define the optimal management strategy for patients presenting with UEDVT, so many conclusions are drawn from smaller, single-center studies or from LEDVT research. In this article, the authors describe the evidence for the currently available treatment options and an approach to a patient with acute UEDVT.

Keywords

upper extremity deep vein thrombosis - Paget-Schroetter syndrome - thrombolysis - pharmacomechanical thrombectomy - interventional radiology

• References

• 1 Kucher N. Clinical practice. Deep-vein thrombosis of the upper extremities. N Engl J Med 2011; 364 (9) 861-869
• 2 Koury JP, Burke CT. Endovascular management of acute upper extremity deep venous thrombosis and the use of superior vena cava filters. Semin Intervent Radiol 2011; 28 (1) 3-9
• 3 Greenberg J, Troutman DA, Shubinets V, Dougherty MJ, Calligaro KD. Phlegmasia cerulea dolens in the upper extremity: a case report and systematic review and outcomes analysis. Vasc Endovascular Surg 2016; 50 (2) 98-101
• 4 Muñoz FJ, Mismetti P, Poggio R , et al; RIETE Investigators. Clinical outcome of patients with upper-extremity deep vein thrombosis: results from the RIETE Registry. Chest 2008; 133 (1) 143-148
• 5 Lamontagne F, McIntyre L, Dodek P , et al; Prophylaxis for Thromboembolism in Critical Care Trial Investigators; Canadian Critical Care Trials Group; Australian and New Zealand Intensive Care Society Clinical Trials Group. Nonleg venous thrombosis in critically ill adults: a nested prospective cohort study. JAMA Intern Med 2014; 174 (5) 689-696
• 6 Grant JD, Stevens SM, Woller SC , et al. Diagnosis and management of upper extremity deep-vein thrombosis in adults. Thromb Haemost 2012; 108 (6) 1097-1108
• 7 Kahn SR, Galanaud JP, Vedantham S, Ginsberg JS. Guidance for the prevention and treatment of the post-thrombotic syndrome. J Thromb Thrombolysis 2016; 41 (1) 144-153
• 8 Prandoni P, Bernardi E, Marchiori A , et al. The long term clinical course of acute deep vein thrombosis of the arm: prospective cohort study. BMJ 2004; 329 7464 484-485
• 9 Nicolaides A, Hull RD, Fareed J ; Cardiovascular Disease Educational and Research Trust; European Venous Forum; North American Thrombosis Forum; International Union of Angiology and Union Internationale du Phlebologie. Thrombolytic therapy. Clin Appl Thromb Hemost 2013; 19 (2) 198-204
• 10 Kurli V, Pryluck DS, Singh CK, Clark TW. Acute upper extremity deep venous thrombosis. In: Mauro MA, Murphy KPJ, Thomson KR, Venbrux AC, Morgan RA, , eds. Image-Guided Interventions, 2nd ed. Philadelphia, PA: Saunders; 2014: 766-771
• 11 Arnhjort T, Nordberg J, Delle M, Borgis CJ, Rosfors S, Lärfars G. The importance of the costoclavicular space in upper limb primary deep vein thrombosis, a study with magnetic resonance imaging (MRI) technique enhanced by a blood pool agent. Eur J Intern Med 2014; 25 (6) 545-549
• 12 Tilney ML, Griffiths HJ, Edwards EA. Natural history of major venous thrombosis of the upper extremity. Arch Surg 1970; 101 (6) 792-796
• 13 Wadhawan A, Laage Gaupp FM, Sista AK. Automatic implantable cardiac defibrillator implantation may precipitate effort-induced thrombosis in young athletes: a case report and literature review. Clin Imaging 2014; 38 (4) 510-514
• 14 Itkin M, Mondshein JI, Stavropoulos SW, Shlansky-Goldberg RD, Soulen MC, Trerotola SO. Peripherally inserted central catheter thrombosis--reverse tapered versus nontapered catheters: a randomized controlled study. J Vasc Interv Radiol 2014; 25 (1) 85-91.e1
• 15 Greene MT, Flanders SA, Woller SC, Bernstein SJ, Chopra V. The association between PICC use and venous thromboembolism in upper and lower extremities. Am J Med 2015; 128 (9) 986-93.e1
• 16 Chopra V, Ratz D, Kuhn L, Lopus T, Lee A, Krein S. Peripherally inserted central catheter-related deep vein thrombosis: contemporary patterns and predictors. J Thromb Haemost 2014; 12 (6) 847-854
• 17 Chopra V, Fallouh N, McGuirk H , et al. Patterns, risk factors and treatment associated with PICC-DVT in hospitalized adults: a nested case-control study. Thromb Res 2015; 135 (5) 829-834
• 18 Bertoglio S, Faccini B, Lalli L, Cafiero F, Bruzzi P. Peripherally inserted central catheters (PICCs) in cancer patients under chemotherapy: a prospective study on the incidence of complications and overall failures. J Surg Oncol 2016; 113 (6) 708-714
• 19 Mino JS, Gutnick JR, Monteiro R, Anzlovar N, Siperstein AE. Line-associated thrombosis as the major cause of hospital-acquired deep vein thromboses: an analysis from National Surgical Quality Improvement Program data and a call to reassess prophylaxis strategies. Am J Surg 2014; 208 (1) 45-49
• 20 Trerotola SO, Stavropoulos SW, Mondschein JI , et al. Triple-lumen peripherally inserted central catheter in patients in the critical care unit: prospective evaluation. Radiology 2010; 256 (1) 312-320
• 21 Delluc A, Le Gal G, Scarvelis D, Carrier M. Outcome of central venous catheter associated upper extremity deep vein thrombosis in cancer patients. Thromb Res 2015; 135 (2) 298-302
• 22 Kearon C, Akl EA, Ornelas J , et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149 (2) 315-352
• 23 Lenchus JD, Biehl M, Cabrera J, de Moraes AG, Dezfulian C. In-hospital management and follow-up treatment of venous thromboembolism: focus on new and emerging treatments. J Intensive Care Med 2016; ;pii:0885066616648265
• 24 Lavau-Denes S, Lacroix P, Maubon A , et al. Prophylaxis of catheter-related deep vein thrombosis in cancer patients with low-dose warfarin, low molecular weight heparin, or control: a randomized, controlled, phase III study. Cancer Chemother Pharmacol 2013; 72 (1) 65-73
• 25 Fallouh N, McGuirk HM, Flanders SA, Chopra V. Peripherally inserted central catheter-associated deep vein thrombosis: a narrative review. Am J Med 2015; 128 (7) 722-738
• 26 Mizuno A, Anzai H, Utsunomiya M , et al; EDO registry investigators. Real clinical practice of catheter therapy for deep venous thrombosis: periprocedural and 6-month outcomes from the EDO registry. Cardiovasc Interv Ther 2015; 30 (3) 251-259
• 27 Enden T, Haig Y, Kløw NE , et al; CaVenT Study Group. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet 2012; 379 9810 31-38
• 28 Enden T, Wik HS, Kvam AK, Haig Y, Kløw NE, Sandset PM. Health-related quality of life after catheter-directed thrombolysis for deep vein thrombosis: secondary outcomes of the randomised, non-blinded, parallel-group CaVenT study. BMJ Open 2013; 3 (8) e002984
• 29 Bader KB, Bouchoux G, Holland CK. Sonothrombolysis. Adv Exp Med Biol 2016; 880: 339-362
• 30 Engelberger RP, Spirk D, Willenberg T , et al. Ultrasound-assisted versus conventional catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis. Circ Cardiovasc Interv 2015; 8 (1) e002027
• 31 Zangan S, Funaki B. Thrombectomy devices. In: Mauro MA, Murphy KPJ, Thomson KR, Venbrux AC, Morgan RA, , eds. Image-Guided Interventions, 2nd ed. Philadelphia, PA: Saunders; 2014: 766-771
• 32 Chaudhry MA, Pappy R, Hennebry TA. Use of the trellis device in the management of deep vein thrombosis: a retrospective single-center experience. J Invasive Cardiol 2013; 25 (6) 296-299
• 33 Spivack A, Troutman D, Dougherty M, Calligaro K. Changing strategies to treat venous thrombotic occlusions of the upper and lower extremities secondary to compressive phenomena. Vasc Endovascular Surg 2013; 47 (4) 274-277
• 34 Dandoy CE, Kukreja KU, Gruppo RA, Patel MN, Tarango C. Outcomes in children with deep vein thrombosis managed with percutaneous endovascular thrombolysis. Pediatr Radiol 2015; 45 (5) 719-726
• 35 Kukreja KU, Lungren MP, Patel MN , et al. Endovascular venous thrombolysis in children younger than 24 months. J Vasc Interv Radiol 2014; 25 (8) 1158-1164
• 36 Lungren MP, Ward TJ, Patel MN, Racadio JM, Kukreja K. Endovascular thrombolysis to salvage central venous access in children with catheter-associated upper extremity deep vein thrombosis: technique and initial results. J Thromb Thrombolysis 2015; 40 (3) 274-279
• 37 Vedantham S, Goldhaber SZ, Kahn SR , et al. Rationale and design of the ATTRACT Study: a multicenter randomized trial to evaluate pharmacomechanical catheter-directed thrombolysis for the prevention of postthrombotic syndrome in patients with proximal deep vein thrombosis. Am Heart J 2013; 165 (4) 523-530.e3
• 38 Lugo J, Tanious A, Armstrong P , et al. Acute Paget-Schroetter syndrome: does the first rib routinely need to be removed after thrombolysis?. Ann Vasc Surg 2015; 29 (6) 1073-1077
• 39 Johansen KH, Illig KA. Conservative (non-operative) treatment of VTOS. In: Illig KA, Thompson RW, Freischlag JA, Donahue DM, Jordan SE, Edgelow PI, , eds. Thoracic Outlet Syndrome. New York: Springer; 2013: 395-400
• 40 Johansen KH. Controversies in VTOS: is costoclavicular junction decompression always needed in VTOS. ? In: Illig KA, Thompson RW, Freischlag JA, Donahue DM, Jordan SE, Edgelow PI, , eds. Thoracic Outlet Syndrome. New York: Springer; 2013: 513-515
• 41 Lee JT. Controversies in VTOS: timing of first rib resection after thrombolysis. In: Illig KA, Thompson RW, Freischlag JA, Donahue DM, Jordan SE, Edgelow PI, , eds. Thoracic Outlet Syndrome. New York: Springer; 2013: 517-520
• 42 van den Houten MM, van Grinsven R, Pouwels S, Yo LS, van Sambeek MR, Teijink JA. Treatment of upper-extremity outflow thrombosis. Phlebology 2016; 31 (1, Suppl): 28-33
• 43 Owens CA, Bui JT, Knuttinen MG, Gaba RC, Carrillo TC. 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
• 44 Morrison HL. Catheter-directed thrombolysis for acute limb ischemia. Semin Intervent Radiol 2006; 23 (3) 258-269
• 45 Eisenberg PR, Sobel BE, Jaffe AS. Characterization in vivo of the fibrin specificity of activators of the fibrinolytic system. Circulation 1988; 78 (3) 592-597
• 46 Sakharov DV, Rijken DC. Superficial accumulation of plasminogen during plasma clot lysis. Circulation 1995; 92 (7) 1883-1890