Download PDF
Semin Thromb Hemost 2002; 28(1): 89-100
DOI: 10.1055/s-2002-20567
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Upper Extremity Deep Venous Thrombosis

Aruna Kommareddy, Michael H. Zaroukian, Houria I. Hassouna
  • Department of Medicine, Michigan State University, East Lansing, Michigan
Further Information

Publication History

Publication Date:
05 March 2002 (online)

    Permissions and Reprints

ABSTRACT

Upper extremity deep venous thrombosis (UEDVT) makes up approximately 1-4% of all episodes of deep venous thrombosis (DVT). Risk factors for UEDVT include central venous catheterization, strenuous upper extremity exercise or anatomic abnormalities causing venous compression, inherited thrombophilia, and acquired hypercoagulable states including pregnancy, oral contraceptive use, and cancer. Unexplained or recurrent UEDVT should prompt a search for inherited hypercoagulable states or underlying malignancy. Clinical presentations include arm, neck, and shoulder pain; edema; skin discoloration; tenderness; and venous distension. Because UEDVT is frequently asymptomatic until complications ensue, a high index of suspicion is required for patients with one or more risk factors for thrombosis. Pulmonary embolism and post-thrombotic syndrome are the most common sequelae of UEDVT. Early detection and treatment of UEDVT decrease complications, morbidity, and mortality. Compressive ultrasonography is an effective and economical means of confirming the clinical diagnosis in most patients. Traditional anticoagulant therapy of UEDVT is giving way to a multimodal approach involving transcatheter thrombolytic therapy followed by a minimum of 3 months of warfarin sodium anticoagulant therapy, venous decompression as needed, and balloon angioplasty with stenting for treatment of residual stricture. Low-dose anticoagulant therapy can safely and effectively mitigate the increased risk of UEDVT associated with the use of central venous catheters.

KEYWORD

Upper extremity - deep venous thrombosis - Paget-Schroetter syndrome - catheters - pulmonary embolism

REFERENCES

  • 1 Quinn C, Hill J, Hassouna H. Thrombotic risk and laboratory testing. A guide for diagnosis of patients with arterial and venous thrombosis.  Clin Lab Sci . 2000;  13 229-238
    PubMedGoogle Scholar
  • 2 Hill S L, Berry R E. Subclavian vein thrombosis: a continuing challenge.  Surgery . 1990;  108 1-9
    PubMedGoogle Scholar
  • 3 Chastre J, Cornud F, Bouchama A. Thrombosis as a complication of pulmonary-artery catheterization via the internal jugular vein: prospective evaluation by phlebography.  N Engl J Med . 1982;  306 278-281
    PubMedGoogle Scholar
  • 4 Timsit J F, Farkas J C, Boyer J M. Central vein catheter related thrombosis in intensive care patients. Incidence, risk factors, and relationship with catheter related sepsis.  Chest . 1998;  114 207-213
    CrossrefPubMedGoogle Scholar
  • 5 Heron E, Lozinguez O, Alhenc-Gelas M. Hypercoagulable states in primary upper-extremity deep vein thrombosis.  Arch Intern Med . 2000;  160 382-386
    CrossrefPubMedGoogle Scholar
  • 6 Ellis M H, Manor Y, Witz M. Risk factors and management of patients with upper limb deep vein thrombosis.  Chest . 2000;  117 43-46
    CrossrefPubMedGoogle Scholar
  • 7 Provenzale J, Ortel T, Allen N. Systemic thrombosis in patients with antiphospholipid antibodies: lesion distribution and imaging findings.  AJR . 1998;  170 285-290
    PubMedGoogle Scholar
  • 8 Prandoni P, Polistena P, Bernardi E. Upper extremity deep vein thrombosis: risk factors, diagnosis and complications.  Arch Intern Med . 1997;  157 57-62
    CrossrefPubMedGoogle Scholar
  • 9 Cable G G. Hyperhomocysteinemia and upper extremity deep venous thrombosis: a case report.  Aviat Space Environ Med . 1999;  70 701-704
    PubMedGoogle Scholar
  • 10 Sayinalp N, Ozcebe O I, Kirazli S. Paget-Schroetter syndrome associated with FV: Q506 and prothrombin G20210A-a case report.  Angiology . 1999;  50 689-692
    PubMedGoogle Scholar
  • 11 Martinelli I, Cattaneo M, Panzeri D. Low prevalence of thrombophilic coagulation defects in patients with deep vein thrombosis of the upper extremities.  Ann Intern Med . 1997;  126 707-711
    PubMedGoogle Scholar
  • 12 Arkel Y S. Thrombosis and cancer.  Semin Oncol . 2000;  27 362-374
    PubMedGoogle Scholar
  • 13 Whigham C J, Greenbaum M C, Fisher R G. Incidence and management of catheter occlusion in implantable arm ports: results in 391 patients.  J Vasc Interv Radiol . 1999;  10 767-774
    PubMedGoogle Scholar
  • 14 De Cicco M, Matovic M, Balestreri L. Antithrombin III deficiency as a risk factor for catheter related central vein thrombosis in cancer patients.  Thromb Res . 1995;  78 127-137
    CrossrefPubMedGoogle Scholar
  • 15 Hung S S. Deep vein thrombosis of the arm associated with malignancy.  Cancer . 1989;  64 531-535
    PubMedGoogle Scholar
  • 16 Sheeran S R, Hallisey M J, Murphy T P. Local thrombolytic therapy as part of multidisciplinary approach to acute axillosubclavian vein thrombosis (Paget-Schroetter syndrome).  J Vasc Interv Radiol . 1997;  8 253-260
    PubMedGoogle Scholar
  • 17 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
  • 18 Reed J D, Harman J T, Harris V. Regional fibrinolytic therapy for iatrogenic subclavian vein thrombosis.  Semin Intervent Radiol . 1992;  9 183-189
    PubMedGoogle Scholar
  • 19 Kerr T M, Lutter K S, Moeller D M. Upper extremity venous thrombosis diagnosed by duplex scanning.  Am J Surg . 1990;  160 202-206
    PubMedGoogle Scholar
  • 20 Hoshal V, Ause R, Hoskins P. Fibrin sleeve formation on indwelling subclavian central venous catheters.  Arch Surg . 1971;  102 353-358
    CrossrefPubMedGoogle Scholar
  • 21 Brismar B, Hardstedt C, Jacobson S. Diagnosis of thrombosis by catheter phlebography after prolonged central venous catheterization.  Ann Surg . 1981;  194 779-783
    CrossrefPubMedGoogle Scholar
  • 22 Ahmed N. Thrombosis after central venous cannulation.  Med J Aust . 1976;  1 217-220
    PubMedGoogle Scholar
  • 23 Martin C, Viviand X, Saux P. Upper extremity deep vein thrombosis after central venous catheterization via axillary vein.  Crit Care Med . 1999;  27 2626-2629
    PubMedGoogle Scholar
  • 24 Hernandez D, Diaz F, Rufino M. Subclavian vascular access stenosis in dialysis patients: natural history and risk factors.  J Am Soc Nephrol . 1998;  9 1507-1510
    CrossrefPubMedGoogle Scholar
  • 25 Kearns P J, Coleman S, Wehner J H. Complications of long arm catheters: a randomized trial of central vs peripheral tip location.  J Parenter Enteral Nutr . 1996;  20 20-24
    CrossrefPubMedGoogle Scholar
  • 26 Koksoy C, Kuzu A, Erden I. The risk factors in central venous catheter related thrombosis.  Aust NZ J Surg . 1995;  65 796-798
    PubMedGoogle Scholar
  • 27 Hingorani A, Ascher E, Hanson J. Upper versus lower extremity deep venous thrombosis.  Am J Surg . 1997;  174 214-217
    CrossrefPubMedGoogle Scholar
  • 28 Ciocon J O, Galindo-Ciocon D. Arm edema, subclavian thrombosis, and pacemakers-a case report.  Angiology . 1998;  49 315-319
    PubMedGoogle Scholar
  • 29 Barazzoni G. Vein patency in patients with pacemaker implanted via subclavian vein: digital phlebography assessment.  Radiol Med (Torino) . 1997;  93 552-555
    PubMedGoogle Scholar
  • 30 Lin L J, Lin J L, Tsai W C. Venous access thrombosis detected by transcutaneous vascular ultrasound in patients with single-polyurethane-lead permanent.  Pacing Clin Electrophysiol . 1998;  21 396-400
    PubMedGoogle Scholar
  • 31 Andes D R, Urban A W, Acher C W. Septic thrombosis of the basilic, axillary, and subclavian veins caused by a peripherally inserted central venous catheter.  Am J Med . 1998;  105 446-450
    CrossrefPubMedGoogle Scholar
  • 32 Ault M, Artal R. Upper extremity DVT. What is the risk?.  Arch Intern Med . 1998;  158 1950-1951
    CrossrefPubMedGoogle Scholar
  • 33 Go R S, Call T G. Deep venous thrombosis of the arm after intravenous immunoglobulin infusion: case report and literature review of intravenous immunoglobulin-related thrombotic complications.  Mayo Clin Proc . 2000;  75 83-85
    PubMedGoogle Scholar
  • 34 Kurgan A, Abramowitz H, Shapiro J. Traumatic axillary and subclavian vein thrombosis after seat belt injury.  J Vasc Nurs . 1997;  15 134-135
    PubMedGoogle Scholar
  • 35 Prandoni P, Bernadi E. Upper extremity deep vein thrombosis.  Curr Opin Pulm Med . 1999;  5 222-226
    CrossrefPubMedGoogle Scholar
  • 36 Horattas M C, Wright D J, Fenton A H. Changing concepts of deep venous thrombosis of the upper extremity- report of a series and review of the literature.  Surgery . 1988;  104 561-567
    PubMedGoogle Scholar
  • 37 Louis J. Axillary vein thrombosis mimicking muscular strain.  J Accid Emerg Med . 1999;  16 233-234
    PubMedGoogle Scholar
  • 38 Legere B, Dweik R, Arroliga A. Venous thromboembolism in the intensive care unit.  Clin Chest Med . 1999;  20 367-384
    PubMedGoogle Scholar
  • 39 Kooij J D, van der Zant M F, van Beek J E. Pulmonary embolism in deep venous thrombosis of upper extremity: more often in catheter-related thrombosis.  Neth J Med . 1997;  50 238-242
    PubMedGoogle Scholar
  • 40 Monreal M, Lafoz E, Ruiz J. Upper-extremity deep venous thrombosis and pulmonary embolism. A prospective study.  Chest . 1991;  99 280-283
    CrossrefPubMedGoogle Scholar
  • 41 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
  • 42 Leebeek F W, Kappers-Klunne M C, Gomez-Garcia E B. Deep venous thrombosis of the arm: etiology, diagnosis and treatment.  Ned Tijdschr Geneeskd . 2000;  144 361-364
    PubMedGoogle Scholar
  • 43 Kaufman B R, Zoldos J, Bentz M. Venous gangrene of the upper extremity.  Ann Plast Surg . 1998;  40 370-377
    PubMedGoogle Scholar
  • 44 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
  • 45 Prescott S M, Tikoff G. Deep venous thrombosis of upper extremity: a reappraisal.  Circulation . 1979;  59 350-355
    CrossrefPubMedGoogle Scholar
  • 46 Nordstrom M, Lindblad B, Anderson H. Deep venous thrombosis and occult malignancy: an epidemiological study.  BMJ . 1994;  308 891-894
    CrossrefPubMedGoogle Scholar
  • 47 Fraser J D, Anderson D R. Deep venous thrombosis: recent advances and optimal investigation with US.  Radiology . 1999;  211 9-24
    PubMedGoogle Scholar
  • 48 Salcuni M, Fiorentino P, Pedicelli A. Diagnostic imaging in deep vein thrombosis of the limbs.  Rays . 1996;  21 328-339
    PubMedGoogle Scholar
  • 49 Elliott G. Upper-extremity deep vein thrombosis.  Lancet . 1997;  349 1188-1189
    CrossrefPubMedGoogle Scholar
  • 50 Chang Y C, Dai M H, Wang T C. 2-D time-of-flight (TOF) MRA of thrombophlebitis of upper extremity and subclavian veins. A case report.  Angiology . 1996;  47 1019-1022
    PubMedGoogle Scholar
  • 51 Chang Y C, Su C T, Yang P C. Magnetic resonance angiography in the diagnosis of thoracic venous obstruction.  J Formos Med Assoc . 1998;  97 38-43
    PubMedGoogle Scholar
  • 52 Silverstein A M, Turbiner E H. Technetium-99m red blood cell venography in upper extremity deep venous thrombosis.  Clin Nucl Med . 1987;  12 421-423
    PubMedGoogle Scholar
  • 53 Lockwood C J. Heritable coagulopathies in pregnancy.  Obstet Gynecol Surv . 1999;  54 754-765
    CrossrefPubMedGoogle Scholar
  • 54 Creinin M D, Lisman R, Strickler R C. Screening for factor V Leiden mutation before prescribing combination oral contraceptives.  Fertil Steril . 1999;  72 646-651
    CrossrefPubMedGoogle Scholar
  • 55 WHO Technical Report No 877. Cardiovascular Disease and Steroid Contraception Geneva: World Health Organization 1998
  • 56 McKenzie S, Clare C, Smith L. Laboratory test utilization in the diagnosis of hypercoagulability.  Clin Lab Sci . 2000;  13 215-221
    PubMedGoogle Scholar
  • 57 Adcock D M, Fink L, Marlar R A. A laboratory approach to the evaluation of hereditary hypercoagulability.  Am J Clin Pathol . 1997;  108 434-449
    PubMedGoogle Scholar
  • 58 Van Cott M E, Laposata M. Laboratory evaluation of hypercoagulable states.  Hematol Oncol Clin North Am . 1998;  12 1141-1166
    PubMedGoogle Scholar
  • 59 Savage K J, Wells P S, Schulz V. Outpatient use of low molecular weight heparin (dalteparin) for the treatment of deep vein thrombosis of the upper extremity.  Thromb Haemost . 1999;  82 1008-1010
    PubMedGoogle Scholar
  • 60 Marie I, Levesque H, Cailleux N. Deep venous thrombosis of the upper limbs. Apropos of 49 cases.  Rev Med Interne . 1998;  19 399-408
    PubMedGoogle Scholar
  • 61 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
  • 62 Kunkel J M, Machleder H I. Treatment of Paget-Schroetter syndrome. A staged multidisciplinary approach.  Arch Surg . 1989;  124 1153-1157
    CrossrefPubMedGoogle Scholar
  • 63 Horne M, Mayo D, Cannon R. Intraclot recombinant tissue plasminogen activator in the treatment of deep venous thrombosis of the lower and upper extremities.  Am J Med . 2000;  108 251-255
    CrossrefPubMedGoogle Scholar
  • 64 Spence L D, Gironta M G, Malde H M. Acute upper extremity deep venous thrombosis: safety and effectiveness of superior vena caval filters.  Radiology . 1999;  210 53-58
    PubMedGoogle Scholar
  • 65 Bern M M, Lokich J J, Wallach S R. Very low doses of warfarin can prevent thrombosis in central venous catheters. A randomized prospective trial.  Ann Intern Med . 1990;  112 423-428
    CrossrefPubMedGoogle Scholar
  • 66 Monreal M. Upper extremity deep venous thrombosis in cancer patients with venous access devices-prophylaxis with a low molecular weight heparin (Fragmin).  Thromb Haemost . 1996;  75 251-253
    PubMedGoogle Scholar
  • 67 Saint S, Veenstra D L, Lipsky B A. The clinical and economic consequences of nosocomial central venous catheter-related infection: are antimicrobial catheters useful?.  Infect Control Hosp Epidemiol . 2000;  21 375-380
    PubMedGoogle Scholar
  • 68 Marin M G, Lee J C, Skurnick J H. Prevention of nosocomial blood stream infections: effectiveness of antimicrobial-impregnated and heparin-bonded central venous catheters.  Crit Care Med . 2000;  28 3332-3338
    PubMedGoogle Scholar
  • 69 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
  • 70 Dollery C M, Sullivan I D, Bauraind O. Thrombosis and embolism in long-term central venous access for parenteral nutrition.  Lancet . 1994;  344 1043-1045
    CrossrefPubMedGoogle Scholar