Deep Vein Thrombosis of the Upper Extremity - PubMed (original) (raw)

Deep Vein Thrombosis of the Upper Extremity

Jan Heil et al. Dtsch Arztebl Int. 2017.

Abstract

Background: Deep venous thrombosis (DVT) arises with an incidence of about 1 per 1000 persons per year; 4-10% of all DVTs are located in an upper extremity (DVT-UE). DVT-UE can lead to complications such as post-thrombotic syndrome and pulmonary embolism and carries a high mortality.

Methods: This review is based on pertinent literature, published from January 1980 to May 2016, that was retrieved by a systematic search, employing the PRISMA criteria, carried out in four databases: PubMed (n = 749), EMBASE (n = 789), SciSearch (n = 0), and the Cochrane Library (n = 12). Guidelines were included in the search.

Results: DVT-UE arises mainly in patients with severe underlying diseases, especially cancer (odds ratio [OR] 18.1; 95% confidence interval [9.4; 35.1]). The insertion of venous catheters-particularly central venous catheters-also elevates the risk of DVT-UE. Its clinical manifestations are nonspecific. Diagnostic algorithms are of little use, but ultrasonography is very helpful in diagnosis. DVT-UE is treated by anticoagulation, with heparin at first and then with oral anticoagulants. Direct oral anticoagulants are now being increasingly used. The thrombus is often not totally eradicated. Anticoagulation is generally continued as maintenance treatment for 3-6 months. Interventional techniques can be used for special indications. Patients with DVT-UE have a high mortality, though they often die of their underlying diseases rather than of the DVT-UE or its complications.

Conclusion: DVT of the upper extremity is becoming increasingly common, though still much less common than DVT of the lower extremity. The treatment of choice is anticoagulation, which is given analogously to that given for DVT of the lower extremity.

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Figures

Figure 1

Figure 1

Diagnostic algorithm based on the Constans criteria (modified from [22, 23]) CVC, central venous catheter; DVT-UE, deep vein thrombosis of the upper extremity

Figure 2

Figure 2

Sonography of the left subclavian vein Depiction of a several-day-old thrombus with almost complete obstruction of the lumen (arrow)

Figure 3

Figure 3

Computed tomographic (CT) image of deep vein thrombosis of the upper extremity. Verification of the longitudinally extensive thrombus at the junction of the right subclavian vein and the superior vena cava (arrow)

Figure 4

Figure 4

Phlebography of the brachial vein. The abrupt ending of the contrast medium column demonstrates the presence of a thrombus in the axillary vein with only slight collateralization (arrow)

eFigure

eFigure

PRISMA diagram (PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analyses)

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