The diagnosis, treatment, and longterm sequelae of lower extremity deep venous thrombosis dvt depend on the anatomic location and extent of the process, yet a lack of such fundamental knowledge has limited the development of effective protocols for managing patients with dvt. Upper extremity deep vein thrombosis uedvt accounts for approximately 5 to 10 percent of all cases of dvt with incidence increasing due to higher frequency of intravenous catheter use. A clinical trial was recently completed in cancer and non. However thromboses can occur anywhere in the body, i once had a patient who had one in the end of her thumb bizarrely. Upper extremity deep venous thrombosis vascular medicine. The evidence on the diagnostic management of upper extremity deep vein thrombosis is scarce. Upper extremity deep vein thrombosis, or uedvt for short, is dvt in the arms. There is an incidence of about 5% to 10% of upper extremity dvts. Av fistula, catheter thrombolysis, unilateral upper limb edema, upper extremity deep vein thrombosis introduction up to 10% of all deep vein thrombosis dvt are related to upper extremity, occurring at an incidence of about 3 per 100,000 in the general population. Svt with a deep vein thrombosis andor hypercoagulable conditions andor. Findings of acute venous thrombosis involving upper limb. Only one study evaluated the use of a diagnostic algorithm, similar to the one used for deep vein thrombosis of the lower extremities. Limited usefulness of ddimer in suspected deep vein thrombosis of the upper extremities. Upper extremity deep vein thrombosis may occur when a blood clot forms in a specific location.
Changing concepts of deep venous thrombosis of the upper extremity. Overview of the treatment of lower extremity deep vein. Upper extremity deepvein thrombosis dvt is an increasingly common clinical problem and has been found to cause important pulmonary embolism in up to 36% of cases including fatal embolism. What does upper extremity deep vein thrombosis mean. However, as many as 20% of patients present with apparently spontaneous episodes. When deep vein thrombosis occurs in the upper limb british. Pdf upper extremity deep venous thrombosis uedvt makes up approximately 14% of all. Physical examination revealed marked swelling with pitting edema and cyanosis.
Deep vein thrombosis in orthopedic surgery of the lower. Accuracy of diagnostic tests for clinically suspected upper extremity deep vein thrombosis. Upper extremity deep vein thrombosis health guide info. The diagnostic management of upper extremity deep vein. Pulmonary embolism pe is present in up to one third of patients with uedvt. Dec 14, 2014 a deep vein thrombosis dvt as the name implies occur in the deeper veins, and usually in the lower leg. Ddimer to guide the duration of anticoagulation in patients with venous thromboembolism. Deep vein venous thrombosis dvt is a condition where a thrombus blood clot forms in the veins of the body. Deep vein thrombosis of the upper extremity request pdf. A deep vein thrombosis dvt occurs when a blood clot forms in a vein deep inside your body. Upper extremity deep vein thrombosis in a patient with hemorrhagic strokea case reporthemorajik inmeli bir hastada ust ekstremite derin ven trombozu. Listing a study does not mean it has been evaluated by the u.
In addition, as many as 25% to 30% of patients undergoing vascular surgery may have an associated hypercoagulable condition. Upper extremity deep vein thrombosis pubmed central pmc. Probability of developing proximal deep vein thrombosis andor pulmonary embolism after distal deep vein thrombosis. Treatment of upper extremity deepvein thrombosis full text. However, upper limb dvts, in general, are very rare. The ageadjusted attack rate per 100,000 population of upper extremity deep vein thrombosis was 16 95% confidence interval ci, 20 compared with 91 95% ci, 83100 for lower extremity. Oct 26, 2016 apixaban for routine management of upper extremity deep venous thrombosis armdvt the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The true incidence of upper extremity deep vein thrombosis dvt in this setting is difficult to estimate since there are very few studies in which dvt diagnosis was based on objective tests, but. See central venous catheterrelated deep vein thrombosis guide superficial vein thrombosis svt. The main problem is a blood clot migrating towards the heart,which creates a medical emergency. Comprehensive management of subclavian vein effort thrombosis. Guidance for the treatment of deep vein thrombosis and. Upper extremity deep vein thrombosis has recently been recognized as being a more common and less benign disease than previously reported. Upper extremity deep vein thrombosis uedvt is defined as thrombosis of the deep venous system subclavian, axillary, brachial, ulnar, and radial veins, which drains the upper extremities.
The anatomy of deep venous thrombosis of the lower extremity. Upper extremity deep vein thrombosis is a relatively rare condition which has thus far not attracted much interest in the literature. It is associated with mechanical factors upper extremity deep vein thrombosis, primary secondary to other anatomic factors upper extremity deep vein thrombosis, secondary. Definition of upper extremity deep vein thrombosis in the definitions.
A physician can perform a series of laboratory and imaging tests to confirm diagnosis and start the patient on home care treatment such as bed rest and add more complex treatments such as medication and. The incidence of upper extremity deep vein thrombosis is 4 to 10 per. The patient was referred to the emergency department for evaluation of suspected deep vein thrombosis dvt in her left upper extremity and pulmonary embolus. Deep vein thrombosis of the upper extremity dvtue can occur in any of the veins of the upper extremity or thoracic inlet. Thrombolysis may be considered on a casebycase basis for patients with uedvt with limb compromise. Venograms with evidence of acute dvt were evaluated, and the extent of the. Chronic embolism and thrombosis of deep veins of low extrm. Treatment should generally follow the principles for lower extremity dvt.
Case reportolgu sunumu, case study by turkish journal of physical medicine and rehabilitation. Oct 28, 2005 upper extremity deep vein thrombosis dvt is an increasingly common clinical problem and has been found to cause important pulmonary embolism in up to 36% of cases including fatal embolism. In the upper extremity the deep veins include the paired radial veins, paired ulnar veins, paired brachial veins, axillary vein. It can be caused by thoracic outlet anatomic obstruction, such as pagetschroetter syndrome, primary or by central intravenous catheters. Due to concern for an upper extremity deep venous thrombosis, the patient was referred back to his primary care physician.
The clinical diagnosis is difficult to make, and various imaging modalities have been used for this purpose. Upper extremity deep vein thrombosis definition of upper. Combined upper and lower extremity deep venous thrombosis. Symptoms may include sudden onset of pain, warmth, redness, blueness, and swelling in the arm. Deep vein thrombosis of the upper extremity is an increasing clinical problem due to the use of longterm indwelling catheters for chemotherapy or longterm feeding. Deep vein thrombosis associated with lower extremity. It arises generally in the presence of recognizable risk factors, such as central venous catheters and cancer. Acute embolism and thrombosis of superficial veins of upper extremity. The right subclavian vein forms an angled arc as it merges with the. Upper extremity deep vein thrombosis uedvt is a rare thrombotic disorder 14% or all dvt, but it has a potential for considerable morbidity in the form of pulmonary embolism, persistent upper extremity pain and swelling, superior vena cava syndrome and loss of vascular access. Pdf deep vein thrombosis in upper limb in a weightlifter. A minority of upper extremity dvts are due to pagetschroetter syndrome, also called effort thrombosis, which occurs in 12 people out of 100,000 a year, usually in athletic males around 30 years of age or in those who.
Pain associated with dvt is often described as being a. Upper extremity deep vein thrombosis uedvt accounts for. Pdf upper extremity deep venous thrombosis researchgate. Other deep veins of the upper extremity that accompany the major. Pathophysiology, diagnosis, and management of upper extremity. Venograms with evidence of acute dvt were evaluated, and the extent of the thrombotic process. Deep vein thrombosis should be suspected in any patient who presents with unexplained extremity swelling, pain, warmth or erythema. Venous thrombosis of the upper extremities springerlink. Proximal dvt proximal lower extremity dvt is thrombus that is located in the popliteal, femoral, or iliac veins table 1. Upper extremity deepvein thrombosis has recently been recognized as being a more common and less benign disease than previously reported.
Apixaban for routine management of upper extremity deep. Anticoagulation therapy eg, lowmolecularweight heparin daily should be started promptly for upper extremity deepvein thrombosis, with catheterdirected thrombolysis considered for. Pagetschroetter syndrome is a rare condition characterized by the presence of axillosubclavian thrombus vein in an otherwise normal individual. The use of interventional radiological procedures has been advancing in recent years. It is generally assumed that the occurrence of upper extremity deep vein thrombosis has increased in the last several decades. Uedvt, or upper extremity deep vein thrombosis, occurs in the arms. In the emergency department, she had a regular heart rate of 96 beatsmin and an oxygen saturation of 95% on room air. The goals of treating patients with upper extremity deep vein thrombosis uedvt are to relieve acute symptoms of venous occlusion, prevent pulmonary embolism, reduce the likelihood of recurrent thrombosis, and avoid the development of postphlebitic syndrome.
Upperextremity deep vein thrombosis uedvt accounts for 10% of cases of deep vein thrombosis. Spontaneous deep vein thrombosis in the upper extremity of. The differences in its aetiopathology, different diagnostic mod. Deep vein thrombosis in upper limb in a weightlifter article pdf available in macedonian journal of medical sciences 52 march 2017 with 78 reads how we measure reads. Apixaban for routine management of upper extremity deep venous. Upperextremity deep vein thrombosis uedvt, which usually refers to thrombosis of the axillary or subclavian veins, occurs spontaneously or sometimes develops as a complication of pacemaker use, longterm central venous catheter cvc use, or cancer. Diagnosis and management of deep vein thrombosis of the upper. The major risk factor for development of dvt is presence of a central venous catheter in which up to 30% of patients may develop venous thrombosis. The prevalence appears to be increasing, particularly because of an increased use of indwelling central venous catheters. The goals of treating patients with upperextremity deep vein thrombosis uedvt are to relieve acute symptoms of venous occlusion, prevent pulmonary embolism, reduce the likelihood of recurrent thrombosis, and avoid the development of postphlebitic syndrome. Management of deep vein thrombosis of the upper extremity.
Upperextremity deep vein thrombosis uedvt is an increasingly important clinical entity with potential for considerable morbidity. Echogenic, noncompressible lumen is noted involving left internal jugular, external jugular, subclavian, brachial, ulnar radial veins. Upper extremity deep venous thrombosis and pulmonary embolism. Pain associated with dvt is often described as being a cramp or ache in the calf or thigh. Information and translations of upper extremity deep vein thrombosis in the most comprehensive dictionary definitions resource on the web. Upper extremity deep vein thrombosis in a patient with. These include the jugular, brachiocephalic, subclavian, and axillary. Signs and symptoms include pain and swelling in the arm, tingling, protruding of the affected vein and discoloration. Acute lower extremity deep vein thrombosis thoracic key. Although the details of management differ, depending on the underlying cause and precipitating factors, anticoagulant therapy should be. Our first effort uses ebook readers, which have several ease of reading features already built in. Probability of developing proximal deepvein thrombosis andor pulmonary embolism after distal deepvein thrombosis. Dvt occurs in the upper extremities in about 410% of cases, with an incidence of 0. Although the details of management differ, depending on the underlying cause and precipitating factors, anticoagulant.
Upper extremity deep vein thrombosis american college of. In some cases of thrombosis in large veins, the cephalad end of the thrombus may not be attached to the vein wall free floating and it may be seen to move. May 06, 2016 a deep vein thrombosis dvt occurs when a blood clot forms in a vein deep inside your body. Upper extremity deep vein thrombosis uedvt healthline. Health, general pulmonary embolism risk factors stroke case studies complications and side effects stroke. Apixaban for routine management of upper extremity deep venous thrombosis armdvt the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Dvt of the upper extremity is compared with dvt of the lower extremity. The use of catheters and surgical interventions in refrac.
Anticoagulant therapy is indicated for all patients with proximal dvt, regardless. Upper extremity deep venous thrombosis is a serious disease entity which, based on. Further studies are needed to validate the algorithm, especially in highrisk subgroups. Upper extremity deep venous thrombosis uedvt accounts. While many clinical aspects of lower extremity deep venous thrombosis ledvt have been explored, there is a relative paucity of data in the literature concerning upper extremity deep venous thrombosis uedvt.
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