Upper Extremity Deep Venous Thrombosis (UEDVT)

Abstract

Upper extremity Deep Venous Thrombosis (UEDVT) is frequent in the hospital, especially in the intensive care unit. It often complicates the placement of central venous catheters (CVC), notably peripherally inserted central (PICC) lines. Despite a lower rate of pulmonary embolism, UEDVT is as fatal as lower extremity DVT. This is due to its strong association with cancer. Symptoms are often absent, but systematic screening is not recommended. The best prophylaxis is good central catheter management. Pharmacological prophylaxis has questionable effectiveness in the prophylaxis of CVC-associated UEDVT. Compression ultrasonography is the first line diagnostic tool. Treatment is anticoagulation for at least 3 months. A causative central line should be removed as soon as clinically possible. Infrequently, patients with the thoracic outlet syndrome can get an effort related primary UEDVT. It is also known as the Paget-Schroetter syndrome. Along with anticoagulation, surgical referral for decompression of the thoracic outlet is then necessary. The current state of evidence on UEDVT is rather poor, due to the absence of large randomized controlled trials.

A case of upper left extremity deep vein thrombosis with right side middle lobe syndrome

“…Secondary DVT is more common than primary DVT [ 1 ]. Patients with “idiopathic” primary UEDVT (much less likely), when compared with those with effort-related primary UEDVT (i.e., Paget–Schroetter syndrome) tend to be older with a female predominance secondary UEDVT (which comprises the vast majority of cases) arises generally in the presence of recognizable risk factors, such as central venous catheters and cancer [ 2 ]. The current state of evidence on UEDVT is rather poor, due to the absence of large randomized controlled trials.…”

“…Its incidence, however, increases exponentially when moving to the hospital setting, mainly the intensive care unit. Despite the poor data on this condition, anticoagulation is indicated for acute UEDVT [ 2 ].…”