Upper-Extremity Deep Vein Thrombosis
Upper-extremity deep vein thrombosis (UEDVT) is an increasingly important clinical entity with potential for considerable morbidity. Pulmonary embolism (PE) is present in up to one third of patients with UEDVT.1 Other complications, such as persistent upper-extremity pain and swelling, the superior vena cava (SVC) syndrome, and loss of vascular access, can be disabling and devastating.2 Although once considered rare, UEDVT has become more common over the past several decades. This is directly related to the increasing use of central venous catheters for chemotherapy, bone marrow transplantation, dialysis, and parenteral nutrition. UEDVT has been reported in up to one fourth of patients with these catheters.3 For these reasons, it is imperative that physicians understand UEDVT risk factors, diagnostic options, treatment alternatives, and prophylaxis regimens.
UEDVT most commonly refers to thrombosis of the axillary and/or subclavian veins. UEDVT is classified as primary or secondary on the basis of pathogenesis.
Primary UEDVT is a rare disorder (2 per 100 000 persons per year)4 that refers either to effort thrombosis (the so-called Paget-Schroetter Syndrome) or idiopathic UEDVT. Patients with Paget-Schroetter Syndrome develop spontaneous UEDVT, usually in their dominant arm, after strenuous activity such as rowing, wrestling, weight lifting, or baseball pitching, but are otherwise young and healthy. The heavy exertion causes microtrauma to the vessel intima and leads to activation of the coagulation cascade. Significant thrombosis may occur with repeated insults to the vein wall, especially if mechanical compression of the vessel is also present.5
Thoracic outlet obstruction refers to compression of the neurovascular bundle (brachial plexus, subclavian artery, and subclavian vein) as it exits the thoracic inlet. Although this disorder may initially cause intermittent, positional extrinsic vein compression, repeated trauma to the vessel can result in dense, perivascular, fibrous scar tissue formation that will compress the vein persistently. …