upper extremity deep vein thrombosis (UEDVT)

Etiology

• primary (30%)
  • idiopathic
  • associated with thoracic outlet syndrome (60% of primary UEDVT)
• secondary
  • indwelling catheter-related (45%) larger catheter confers higher risk
  • 10% of patients with pacemakers
  • malignancy confers 8-fold increased risk
  • hypercoagulable state
  • obesity NOT risk factor
  • hormone replacement therapy NOT risk factor

Epidemiology

• not rare
• 4-10% of all DVT

Pathology

• not benign
• more likely to have cancer than patients with lower extremity DVT (38% vs 20%)
• less likely to present with acute pulmonary embolism than patients with lower extremity DVT (9% vs 29%)

Diagnostic criteria

• an algorithm is proprosed, consisting of
  • clinical decision score
    • presence of a central venous catheter or lead
    • localized pain
    • unilateral edema
    • lack of an alternative diagnosis
  • d-dimer testing
  • ultrasonography

Laboratory

see deep vein thrombosis

Radiology

• non-invasive tests
  • ultrasound
    • criteria is failure of venous lumen to fully collapse under gentle pressure from ultrasound transducer/probe
    • 82% sensitivity & specificity vs venography for upper extremity DVT

Complications

• pulmonary emboli (~30%)
• postphlebitic syndrome less common than in patients with lower extremity DVT

Management

• treatment not standardized
• anticoagulation: generally 3 months with target INR of 2.0-3.0
  • see deep vein thrombosis
  • if catheter associated thrombosis, anticoagulation as long as the catheter remains in place
• prognosis:
  • recurrence lower than that for lower extremity DVT
  • patients without catheters & without cancer with have lowest incidence of recurrence (0.5%)

More general terms

• deep vein thrombosis (DVT)