Morbidity and Mortality Associated with Internal Jugular Vein Thromboses

Abstract

The authors have noted a significant incidence of pulmonary embolism and mortality associated with upper extremity deep venous thrombosis (UEDVT). Since there is an association between the site of lower extremity DVT (LEDVT) and pulmonary embolism, they hypothesized that there might also be a correlation between the site of UEDVT and the incidence of pulmonary embolism (PE) and associated mortality. To further elucidate this hypothesis, they analyzed the mortality rate and incidence of PE diagnosed with subclavian/axillary or internal jugular vein thrombosis during a 5-year period at their institution. Two hundred and ten patients were diagnosed with acute internal jugular and/or subclavian/axillary DVT during a 5-year period by duplex scanning. The indications for the duplex examination were upper extremity swelling in 187 (89%) or as part of the work-up for pulmonary embolism in 23 (11%). There were 126 women (60%) and 84, men (40%). The mean age was 67 +/-18 years (range 1-101 years). The patients were divided into 3 groups based on the location of the thrombus: Group I-UEDVT involving the subclavian and/or axillary veins (n = 128); Group II-internal jugular vein thrombosis alone (n = 21); and Group III-concomitant subclavian/axillary and internal jugular vein DVT (n = 61). Risk factors were presence of central venous catheter or pacemaker in 127 patients (60%), malignancy in 78 patients (37%), concomitant lower extremity deep venous thrombosis (LEDVT) in 40 patients (19%), and history of LEDVT in 6 patients (3%). Eighty (38%) patients had more than 1 risk factor. The mean follow-up period was 13 +/-1 months (range 0-49 months). Mortality rates at 1, 3, and 12 months were 13%, 31%, and 40% for Group I; 14%, 33%, and 42% for Group II; and 23%, 44%, and 59% for Group III. The mortality rate in Group I was statistically significantly higher for patients >/=75 years old, patients not treated with anticoagulation, and patients who underwent placement of a central venous line. The same risk factors did not achieve statistical significance in the 2 other groups. The number of patients diagnosed with pulmonary embolism by ventilation/perfusion scans in Groups I, II, and III that could be attributed to the UEDVT solely was 8 (4%), 1 (0.5%), and 3 (2.4%), respectively. Contrary to the initial hypothesis of a relationship between the site of thrombosis and the incidence of pulmonary embolism and mortality, these data showed no statistical differences in mortality rate or incidence of pulmonary embolism among the 3 groups studied. These data also suggest that internal jugular vein thrombosis is a disease process associated with mortality and morbidity rates comparable to those of subclavian/axillary vein thrombosis.

Isolated internal jugular vein thrombosis presenting with seizure: a case report

“…The site of DVT in the upper extremity doesn't seem to affect the mortality rate or the incidence of pulmonary embolism; according to a study that was based on dividing the patients with upper extremity DVT into three groups, group 1 with DVT in subclavian/ axillary vein, group 2 with isolated internal jugular vein and group 3 with concomitant subclavian/axillary with internal jugular vein. The statistical results showed no difference in either mortality rate or the incidence of pulmonary embolism among the 3 groups [8].…”

“…Most common symptoms of IJVT include Fever (83%), leukocytosis (78%), mass or neck swelling (72%), cervical pain (66%), cord sign (39%), sepsis syndrome (39%), pleuropulmonary complications (28%) [4]. Seizures are not a common associated symptom and there's no clear explanation for it; however, it may be contributed to increased intracranial pressure as some of the cases reported in literature of increased intracranial pressure associated with IJVT [8,9]. The most important complications include pulmonary embolism (PE), subclavian vein thrombosis, superior sagittal sinus thrombosis, superior vena cava syndrome, idiopathic intracranial hypertension, and laryngeal and lowerairway edema [7].…”

Evidence Based Management of Spontaneous Internal Jugular Vein Thrombosis: A Literature Review

“…Although, antibiotics are used in the management of IJV thrombosis associated with an infection or where thrombophlebitis is involved [24], their role in the treatment of spontaneous IJV thrombosis is more difficult to evaluate. Antibiotics are often used primarily to treat the possibility of an associated infection.…”

“…There have been minor changes in practice over the years, mainly with the increasing use of low molecular weight heparin. Some case reports describe the use of intravenous heparin [1,12,24], and others [5], the merits of low molecular weight heparin. Anticoagulation with warfarin still seems to be the long term treatment of choice due to the risk of recurrence.…”

“…They also found that 5% of the upper extremity deep venous thrombosis patients would go on to develop a pulmonary embolism. Another recent cohort study [24] looked at morbidity and mortality associated with the site of a thrombosis over a 5 year period. In their study, they identified 21 patients with isolated IJV thrombosis and 61 patients with concomitant subclavian/axillary and IJV.…”