Download PDF
Semin intervent Radiol 2001; 18(2): 171-182
DOI: 10.1055/s-2001-15178
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Upper Extremity Deep Venous Thrombosis

Nilesh H. Patel
  • Department of Radiology, Indiana Unversity School of Medicine, Indiana University Hospital, Indianapolis, Indiana
Further Information

Publication History

Publication Date:
31 December 2001 (online)

Also available at
    Permissions and Reprints

ABSTRACT

Much attention is paid to lower-extremity deep venous thrombosis and its untoward short- and long-term sequelae. However, upper-extremity deep venous thrombosis (UEDVT) can be equally disabling and even life threatening, as in cases of superior vena cava syndrome. The mainstay of therapy for UEDVT is anticoagulation. In selected cases catheter-directed thrombolytic therapy may be needed to (1) rapidly remove the extensive thrombus, (2) reveal the underlying causative lesion, and (3) guide its appropriate treatment.

KEYWORD

Deep vein thrombosis - axillary vein - subclavian vein - superior vena cava syndrome - Paget-Schroetter syndrome - effort vein thrombosis

REFERENCES

  • 1 Virchow R. Metastatical dyscraisae. In: Virchow R, ed. Cellular Pathology as Based upon Physiological and Pathological Histology. Translated from the 2nd German edition by F Chance New York: Dover Publications, Inc. 1858: 230-254
    Google Scholar
  • 2 Prandoni P, Bernardi E. Upper extremity deep vein thrombosis.  Curr Opin Pulm Med . 1999;  5 222-226
    CrossrefPubMedGoogle Scholar
  • 3 Haire W D, Lynch T G, Lund G B, Lieberman R P, Edney J A. Limitations of magnetic resonance imaging and ultrasound-directed (duplex) scanning in the diagnosis of subclavian vein thrombosis.  J Vasc Surg . 1991;  13 391-397
    PubMedGoogle Scholar
  • 4 Hingorani A, Ascher E, Lorenson E. Upper extremity deep venous thrombosis and its impact on morbidity and mortality rates in a hospital-based population.  J Vasc Surg . 1997;  26 853-860
    CrossrefPubMedGoogle Scholar
  • 5 Hoch J R. Management of the complications of long-term venous access.  Semin Vasc Surg . 1997;  10 135-143
    PubMedGoogle Scholar
  • 6 Horattas M C, Wright D J, Fenton A H. Changing concept of deep venous thrombosis of the upper extremity: report of a series and review of the literature.  Surgery . 1988;  104 561-567
    PubMedGoogle Scholar
  • 7 Monreal M, Raventos A, Lerma R. Pulmonary embolism in patients with upper extremity DVT associated to venous central lines: a prospective study.  Thromb Haemost . 1994;  72 548-550
    PubMedGoogle Scholar
  • 8 Hill S L, Berry R E. Subclavian vein thrombosis: a continuing challenge.  Surgery . 1990;  108 1-9
    PubMedGoogle Scholar
  • 9 Machleder H I. Evaluation of a new treatment strategy for Paget-Schroetter syndrome: spontaneous thrombosis of the axillary-subclavian vein.  J Vasc Surg . 1993;  17 305-317
    PubMedGoogle Scholar
  • 10 Machleder H I. Thrombolytic therapy and surgery for primary axillosubclavian vein thrombosis: current approach.  Semin Vasc Surg . 1996;  9 46-49
    PubMedGoogle Scholar
  • 11 Charnsangavej C, Carrasco C H, Wallace S. Stenosis of the vena cava: preliminary assessment of treatment with expandable metallic stents.  Radiology . 1986;  161 295-298
    CrossrefPubMedGoogle Scholar
  • 12 Carrasco C H, Charnsangavej C, Wright K C. Use of the Gianturco self-expanding stent in stenoses of the superior and inferior venae cavae.  J Vasc Interv Radiol . 1992;  3 409-419
    PubMedGoogle Scholar
  • 13 Gray R J, Dolmatch B L, Horton K M, Romolo J L, Zarate A R. Migration of Palmaz stents following deployment for venous stenoses related to hemodialysis access.  J Vasc Interv Radiol . 1994;  5 117-120
    PubMedGoogle Scholar
  • 14 Gray R J, Horton K M, Dolmatch B L. Use of Wallstents for hemodialysis access-related venous stenoses and occlusions untreatable with balloon angioplasty.  Radiology . 1995;  195 479-484
    PubMedGoogle Scholar
  • 15 Quinn S F, Shuman E S, Hall E. Venous stenoses in patients who undergo hemodialysis; treatment with self-expandable endovascular stents.  Radiology . 1992;  183 499-504
    PubMedGoogle Scholar
  • 16 Guest S S, Kirsch C M, Baxter R, Sorooshian M, Young J. Infection of a subclavian venous stent in a hemodialysis patient.  Am J Kidney Dis . 1995;  26 377-380
    CrossrefPubMedGoogle Scholar
  • 17 Vorwerk D, Guenther R W, Mann H. Venous stenosis and occlusion in hemodialysis shunts: follow-up results of stent placement in 65 patients.  Radiology . 1995;  195 140-146
    CrossrefPubMedGoogle Scholar
  • 18 Quinn S F, Schuman E S, Demlow T A. Percutaneous transluminal angioplasty versus endovascular stent placement in the treatment of venous stenoses in patients undergoing hemodialysis: intermediate results.  J Vasc Interv Radiol . 1995;  6 851-855
    CrossrefPubMedGoogle Scholar
  • 19 Beathard G A. Gianturco self-expanding stent in the treatment of stenosis in dialysis access grafts.  Kidney Int . 1993;  43 872-877
    CrossrefPubMedGoogle Scholar
  • 20 Hunter W. History of aneurysm of the aorta with some remarks on aneurysm in general.  Medical Observations and Inquires . 1757;  1 323
    PubMedGoogle Scholar
  • 21 Baker G L, Barnes J H. Superior vena cava syndrome: etiology, diagnosis and treatment.  Am J Crit Care . 1992;  1 54-64
    PubMedGoogle Scholar
  • 22 Abner A. Approach to the patient who presents with superior vena cava syndrome.  Chest . 1993;  103(Suppl) 394-397
    PubMedGoogle Scholar
  • 23 Lokich J J, Goodman R. Superior vena cava syndrome: clinical management.  JAMA . 1975;  231 58-61
    CrossrefPubMedGoogle Scholar
  • 24 Davenport D, Ferree C, Blake D, Raben M. Radiation therapy in the treatment of superior vena caval obstruction.  Cancer . 1978;  42 2600-2603
    CrossrefPubMedGoogle Scholar
  • 25 Perez C A, Presant C A, van Amburg III L A. Management of superior vena cava syndrome.  Semin Oncol . 1978;  5 123-134
    PubMedGoogle Scholar
  • 26 Hochrein J, Bashore T M, O'Laughlin M P, Harrison J K. Percutaneous stenting of superior vena cava syndrome: a case report and review of the literature.  Am J Med . 1998;  104 78-84
    CrossrefPubMedGoogle Scholar
  • 27 Shimm D, Logue G, Rigsby L. Evaluating the superior vena cava syndrome.  JAMA . 1981;  245 951-953
    CrossrefPubMedGoogle Scholar
  • 28 Sculier J, Feld R. Superior vena cava obstruction: recommendations and management.  Cancer Treat Rev . 1985;  12 209-218
    CrossrefPubMedGoogle Scholar
  • 29 Chen J C, Bongard F, Klein S R. A contemporary perspective on superior vena cava syndrome.  Am J Surg . 1990;  160 207-211
    PubMedGoogle Scholar
  • 30 Kee S T, Kinoshita L, Razavi M K. Superior vena cava syndrome: treatment with catheter-directed thrombolysis and endovascular stent placement.  Radiology . 1998;  206 187-193
    CrossrefPubMedGoogle Scholar
  • 31 Laing A DP, Thompson K R, Vrazas J I. Stenting in malignant and benign vena caval obstruction.  Australas Radiol . 1998;  42 313-317
    PubMedGoogle Scholar
  • 32 Sakai K, Satoh T, Yamasaki M, Kitabatake T. The superior vena cava syndrome and its radiotherapy: clinical response and survival.  Nippon Hoshasen Gakkai Zasshi . 1973;  33 300-307
    PubMedGoogle Scholar
  • 33 Lokich J. Superior vena cava syndrome. In: Lockich JJ, ed. Clinical Cancer Medicine Treatment Tactics Boston: GK Hall 1980: 381-391
    Google Scholar
  • 34 Dyet J F, Nicholson A A, Cook A M. The use of the Wallstent endovascular prosthesis in the treatment of malignant obstruction of the superior vena cava.  Clin Radiol . 1993;  48 381-385
    PubMedGoogle Scholar
  • 35 Oudkerk M, Kuijpers T J, Schmitz P I, Loosveld O, de Wit R. Self-expanding metal stents for palliative treatment of superior vena caval syndrome.  Cardiovasc Intervent Radiol . 1996;  19 146-151
    CrossrefPubMedGoogle Scholar
  • 36 Doty D B. Bypass of superior vena cava: six years experience with spiral vein graft for obstruction of superior vena cava due to malignant disease.  J Thorac Cardiovasc Surg . 1982;  83 326-328
    PubMedGoogle Scholar
  • 37 Chacon Lopez-Muniz I J, Garcia Garcia L, Lanciego Perez C. Treatment of superior and inferior vena cava syndromes of malignant cause with Wallstent catheter placed percutaneously.  Am J Clin Oncol . 1997;  20 293-297
    PubMedGoogle Scholar
  • 38 Muckart D J, Neijenhuis P A, Madiba T E. Superior vena caval thrombosis complicating central venous catheterisation and total parenteral nutrition.  South African Journal of Surgery . 1998;  36 48-51
    PubMedGoogle Scholar
  • 39 Rosenblum J, Leef J, Messersmith R, Tomiak M, Bech F. Intravascular stents in the management of acute superior vena cava obstruction of benign etiology.  J Parenter Enter Nutr . 1994;  18 362-366
    CrossrefPubMedGoogle Scholar
  • 40 Doty D B, Doty J R, Jones K W. Bypass of superior vena cava. Fifteen years experience with spiral vein graft for obstruction of superior vena cava caused by benign disease.  J Thorac Cardiovasc Surg . 1990;  99 889-895
    PubMedGoogle Scholar
  • 41 Del Campo C, Casey M T. Vena cava bypass with stented polytetrafluoroethylene bifurcated grafts. A report of 2 cases.  Tex Heart Inst J . 1993;  20 288-292
    PubMedGoogle Scholar
  • 42 Nazarian G K, Austin W R, Wegryn S A. Venous recanalization by metallic stents after failure of balloon angioplasty or surgery: four-year experience.  Cardiovasc Intervent Radiol . 1996;  19 227-233
    CrossrefPubMedGoogle Scholar
  • 43 Sniderman K W. Noncoronary vascular stenting.  Prog Cardiovasc Dis . 1996;  39 141-164
    PubMedGoogle Scholar
  • 44 Wisselink W, Money S R, Becker M O. Comparison of operative reconstruction and percutaneous balloon dilatation for central venous obstruction.  Am J Surg . 1993;  166 200-204
    CrossrefPubMedGoogle Scholar
  • 45 Irving J D, Dondelinger R F, Reidy J F. Gianturco self-expanding stents: clinical experience in the vena cava and large veins.  Cardiovasc Intervent Radiol . 1992;  15 328-333
    CrossrefPubMedGoogle Scholar
  • 46 Dondelinger R F. Invited commentary.  Clin Radiol . 1994;  49 207
    PubMedGoogle Scholar
  • 47 Paget J. Clinical lectures and Essays.  London: Longmans, Green and Co.; 1975
    Google Scholar
  • 48 Von Schroetter L. Erkankungen der Gefasse. In: Nathnagel Handbuch der Pathologie and Therapie Vienna: Holder; 1984
    Google Scholar
  • 49 Hughes E SR. Venous obstruction in the upper extremity (Paget-Schroetter's syndrome). A review of 320 cases.  Surg Gynecol Obstet . 1949;  88 89-127
    PubMedGoogle Scholar
  • 50 Hicken G J, Ameli F M. Management of subclavian-axillary vein thrombosis: a review.  Can J Surg . 1998;  41 13-25
    PubMedGoogle Scholar
  • 51 Holzenbein T, Winkelbauer F, Teleky B, Krauss R, Kretschmer G. Therapy and the natural course of axillary vein thrombosis-review of 765 patients and analysis of our personal patient sample.  Vasa . 1991;  33(Suppl) 107-108
    PubMedGoogle Scholar
  • 52 Lindblad B, Tengborn L, Bergqvist D. Deep vein thrombosis of the axillary-subclavian veins: epidemiologic data, effects of different types of treatment and late sequelae.  Eur J Vasc Surg . 1988;  2 161-165
    PubMedGoogle Scholar
  • 53 Grassi C J, Bettman M A. Effort thrombosis: role of interventional therapy.  Cardiovasc Intervent Radiol . 1990;  13 317-322
    PubMedGoogle Scholar
  • 54 Druy E M, Trout H H, Giordano J M, Hix W R. Lytic therapy in the treatment of axillary and subclavian vein thrombosis.  J Vasc Surg . 1985;  2 821-827
    PubMedGoogle Scholar
  • 55 Malcynski J, O'Donnell Jr F T, Mackey W C, Millan V A. Long-term results of treatment for axillary subclavian vein thrombosis.  Can J Surg . 1993;  36 365-371
    PubMedGoogle Scholar
  • 56 Roos D B. Overview of thoracic outlet syndromes. In: Machleder HI, ed. Vascular Disorders of the Upper Extremity, 2nd ed New York: Futura 1989: 155-177
    Google Scholar
  • 57 Adelman M A, Stone D H, Riles T S. A multidisciplinary approach to the treatment of Paget-Schroetter syndrome.  Ann Vasc Surg . 1997;  11 149-154
    CrossrefPubMedGoogle Scholar
  • 58 Adams J T, DeWeese J A. ``Effort'' thrombosis of the axillary and subclavian veins.  J Trauma . 1971;  11 923-930
    PubMedGoogle Scholar
  • 59 Hurlbert S N, Rutherford R B. Primary subclavian-axillary vein thrombosis.  Ann Vasc Surg . 1995;  9 217-223
    PubMedGoogle Scholar
  • 60 Rutherford R B. Primary subclavian-axillary vein thrombosis: the relative roles of thrombolysis, percutaneous angioplasty, stents, and surgery.  Semin Vasc Surg . 1998;  11 91-95
    PubMedGoogle Scholar
  • 61 Dunant J H. Effort thrombosis, a complication of thoracic outlet syndrome.  Vasa . 1981;  10 322-324
    PubMedGoogle Scholar
  • 62 Donayre C E, White G H, Mehringer S M, Wilson S E. Pathogenesis determines late morbidity of axillosubclavian vein thrombosis.  Am J Surg . 1986;  152 179-184
    CrossrefPubMedGoogle Scholar
  • 63 Roy T M, Byrd Jr P R, Lukeman R, Mathai M. Primary subclavian vein thrombosis and pulmonary embolism.  South Med J . 1997;  90 748-751
    PubMedGoogle Scholar
  • 64 Beygui R E, Olcott C, Dalman R L. Subclavian vein thrombosis: outcome analysis based on etiology and modality of treatment.  Ann Vasc Surg . 1997;  11 247-255
    CrossrefPubMedGoogle Scholar
  • 65 Becker G J, Holden R W, Rabe F E. Local thrombolytic therapy for subclavian and axillary vein thrombosis.  Radiology . 1983;  149 419-423
    PubMedGoogle Scholar
  • 66 Sheeran S R, Hallisey M J, Murphy T P, Faberman R S, Sherman S. Local thrombolytic therapy as part of a multidisciplinary approach to acute axillosubclavian vein thrombosis (Paget-Schroetter syndrome).  J Vasc Interv Radiol . 1997;  8 253-260
    PubMedGoogle Scholar
  • 67 Wilson J J, Zahn C A, Newman H. Fibrinolytic therapy for idiopathic subclavian-axillary vein thrombosis.  Am J Surg . 1990;  159 208-210
    PubMedGoogle Scholar
  • 68 Zimmermann R, Morl H, Harenberg J. Urokinase therapy of subclavian-axillary vein thrombosis.  Klin Wochenschr . 1981;  59 851-856
    CrossrefPubMedGoogle Scholar
  • 69 Kashyap V S, Ahn S S, Machleder H I. Thoracic outlet neurovascular compression: approaches to anatomic decompression and their limitations.  Semin Vasc Surg . 1998;  11 116-122
    PubMedGoogle Scholar
  • 70 Mewissen M W, Seabrook G R, Meissner M H. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry.  Radiology . 1999;  211 39-49
    CrossrefPubMedGoogle Scholar
  • 71 Patel N H. Alternate approaches to central venous access.  Semin Interv Radiol . 1998;  15 325-333
    PubMedGoogle Scholar
  • 72 Fraschini G, Jadeja J, Lawson M. Local infusion of urokinase for the lysis of thrombosis associated with permanent central venous catheters in cancer patients.  J Clin Oncol . 1987;  5 672-678
    PubMedGoogle Scholar