ACR Appropriateness Criteria® Suspected Upper Extremity Deep Vein Thrombosis

Desjardins, Benoı̂t; Hanley, Michael; Steigner, Michael L.; Aghayev, Ayaz; Azene, Ezana M.; Bennett, Stephanie L.; Chandra, Ankur; Hedgire, Sandeep; Lo, Bruce M.; Mauro, David M.; Ptak, Thomas; Singh-Bhinder, Nimarta; Surányi, Pál; Verma, Nupur; Dill, Karin E.

doi:10.1016/j.jacr.2020.01.020

Cited by 13 publications

(12 citation statements)

References 85 publications

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“…Less common signs that may be more indicative of an upper extremity DVT include skin discoloration and visible venous collaterals. According to the American College of Radiology (ACR), the location of the thrombosis typically correlates with the clinical presentation 165 . Unilateral swelling could be due to obstruction of the brachiocephalic, subclavian, or axillary veins.…”

Section: Question: 12 - What Are the Classical Signs If Any Of Upper ...mentioning

confidence: 99%

Recommendations from the ICM-VTE: Shoulder & Elbow

2022

Journal of Bone and Joint Surgery

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The ICM-VTE Shoulder & Elbow Delegates* Question: 1 -Concerning VTE risk, which surgeries can be considered major, and which surgeries can be considered non-major in shoulder and elbow surgery?Response/Recommendation: Shoulder arthroscopy, nonfracture related shoulder arthroplasty, and all elbow procedures can be considered non-major venous thromboembolism (VTE) risk. Fracture related shoulder procedures can be considered major VTE risk.Strength of Recommendation: Limited.Delegates vote: Agree 93.94% Disagree 6.06% Abstain 0.00% (Strong Consensus)Rationale: VTE following shoulder and elbow surgery are rare events. One study reported for all upper extremity deep venous thromboses (DVT) to represent 1% to 4% of all DVT 1 . In the shoulder, surgeries can be divided into arthroscopic, non-fracture shoulder arthroplasty, and fracture related surgeries. In the elbow, surgeries can be divided into arthroscopy, fracture related, and arthroplasty. With respect to these surgeries, several studies have reported VTE rates, however, a majority of this information comes from a collection of level 3 and level 4 evidence along with registry studies.In shoulder arthroscopy, VTE rates are low with reported rates ranging from 0.011% to 0.38% 2-6 . Kuremsky et al., in a retrospective study of 2,872 patients undergoing shoulder arthroscopy reported VTE rate of 0.24% 2 . Jameson et al., in a registry study out of the United Kingdom reported 0.011% VTE rate in a retrospective review of 65,302 shoulder arthroscopy cases 3 . Similarly, Brislin et al., reported VTE rate of 0.38% in a consecutive series of 263 arthroscopic rotator cuff repairs (RCR) 4 . These VTE rates following arthroscopic RCR were similar to rates reported by Hoxie et al., (0.26%) 5 . Additionally, open instability surgeries also comprise higher VTE risk than their arthroscopic counterparts. Goodloe et al., in a registry study compared arthroscopic Bankart repair, open Bankart repair, and Latarjet-Bristow procedure with reported VTE rates of 0.1%, 0.0%, and 0.8%, respectively 7 . Thus, shoulder arthroscopy procedures can be considered non-major concerning VTE risk.

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Section: Question: 12 - What Are the Classical Signs If Any Of Upper ...mentioning

confidence: 99%

Recommendations from the ICM-VTE: Shoulder & Elbow

2022

Journal of Bone and Joint Surgery

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“…In patients with suspected UEDVT, ultrasound with Doppler imaging is considered the best initial screening tool and has greater than 80% sensitivity and specificity 18 ( Fig. 1 ).…”

Section: Diagnosis and Imaging Findingsmentioning

confidence: 99%

“…While ultrasound cannot directly evaluate central occlusions, signs such as dampening of respiratory variations can reliably suggest central venous occlusion from VTOS or malignancy. 18…”

Section: Diagnosis and Imaging Findingsmentioning

confidence: 99%

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Upper Extremity Deep Venous Thrombosis: Etiologies, Diagnosis, and Updates in Therapeutic Strategies

Koethe

Bochnakova

Kaufman

2022

Semin intervent Radiol

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Upper extremity deep vein thrombosis (UEDVT) is responsible for 4 to 10% of all deep vein thrombosis (DVT). Untreated UEDVT can lead to significant disability secondary to the postthrombotic syndrome. To date, there are no randomized trials specifically comparing different therapeutic strategies. Ultimately, optimal management of UEDVT depends on the underlying etiology, patient symptoms, and degree of thrombosis, with supporting evidence primarily extrapolated from lower extremity DVT data. This article will review the classification, presentation, and diagnosis of both primary and secondary UEDVT. In addition, it will discuss updates in clinical guidelines, anticoagulation, endovascular and surgical treatment strategies.

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“…Conventional diagnostic infusion venography (DIV) demonstrates flow dynamics and is highly sensitive and specific with a high negative predictive value, but must be directed to each vascular territory of interest. DIV is considered the reference standard to evaluate the patency of conventional central venous pathways and to document the nature and extent of anatomic abnormality or central venous obstruction …”

Section: Failure Points and Essential Components Of Carementioning

confidence: 99%

Evidence‐Based Strategies and Recommendations for Preservation of Central Venous Access in Children

Baskin

Mermel

Saad

et al. 2019

J Parenter Enteral Nutr

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Children with chronic illness often require prolonged or repeated venous access. They remain at high risk for venous catheter–related complications (high‐risk patients), which largely derive from elective decisions during catheter insertion and continuing care. These complications result in progressive loss of the venous capital (patent and compliant venous pathways) necessary for delivery of life‐preserving therapies. A nonstandardized, episodic, isolated approach to venous care in these high‐need, high‐cost patients is too often the norm, imposing a disproportionate burden on affected persons and escalating costs. This state‐of‐the‐art review identifies known failure points in the current systems of venous care, details the elements of an individualized plan of care, and emphasizes a patient‐centered, multidisciplinary, collaborative, and evidence‐based approach to care in these vulnerable populations. These guidelines are intended to enable every practitioner in every practice to deliver better care and better outcomes to these patients through awareness of critical issues, anticipatory attention to meaningful components of care, and appropriate consultation or referral when necessary.*

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ACR Appropriateness Criteria® Suspected Upper Extremity Deep Vein Thrombosis

Cited by 13 publications

References 85 publications

Recommendations from the ICM-VTE: Shoulder & Elbow

Recommendations from the ICM-VTE: Shoulder & Elbow

Upper Extremity Deep Venous Thrombosis: Etiologies, Diagnosis, and Updates in Therapeutic Strategies

Evidence‐Based Strategies and Recommendations for Preservation of Central Venous Access in Children

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