Upper extremity thrombosis is responsible for around 10% of all cases of DVT (1).
- is seen more often with the increased use of central venous catheters and of cardiac pacemakers and defibrillators
- axillary subclavian veins are often involved
- unlike in patients with lower extremity DVT, upper extremity DVT are typically seen in patients who are younger, leaner, more likely to have a diagnosis of cancer and less likely to have acquired or hereditary thrombophilia
DVT of the upper extremity can be divided as:
- primary (20% of cases)
- venous thoracic outlet syndrome
- effort related thrombosis (Paget-Schroetter syndrome) -
- seen in around two thirds of patients with primary DVT of an upper extremity, majority are young males
- caused by microtrauma to the subclavian vein due to repeated strenuous activity involving force or abduction of the dominant arm (e.g. - painting or doing car repairs or vigorous exercise like swimming, lifting weights)
- idiopathic
- secondary (80% of cases)
- catheter associated thrombosis - indwelling central venous catheter, pacemaker or defibrillator leads
- cancer associated thrombosis
- surgery or trauma of the arm or shoulder
- pregnancy, use of oral contraceptives
Duplex ultrasound is the preferred initial investigation in suspected upper extremity DVT’s (2).
Complications of DVT of the upper extremity (less common than in the lower extremities) include: pulmonary embolism, recurrence at 12 months and the post-thrombotic syndrome (1).
Aim of management is to identify and treat any underlying conditions, alleviate symptoms and to prevent thrombus progression, early recurrence, pulmonary embolism, and the post-thrombotic syndrome (1).
Initial therapy includes low-molecular-weight heparin or unfractionated heparin (in patients with severe renal dysfunction)
- patients without underlying risk factors (such as antiphospholipid antibodies) do not require prolonged (more than 3-6 months) anticoagulant treatment (2)
- routine catheter removal is not recommended in catheter-associated thrombosis except in cases where there is catheter malfunction or infection, if anticoagulation has failed or is contraindicated, or if the catheter is no longer needed (1).
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