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
