Upper extremity deep-vein thrombosis has recently been recognized as being a more common and less benign disease than previously reported. It arises generally in the presence of recognizable risk factors, such as
central venous catheters and
cancer. However, as many as 20% of patients present with apparently spontaneous episodes. The prevalence of inherited coagulation defects in patients with this disease ranges from 10% to 26%. The clinical picture of upper extremity DVT is characterized by
pain,
edema, and functional impairment, although it may be completely asymptomatic. Because the prevalence of this thrombotic disease is less than 50% among symptomatic subjects, objective diagnosis is mandatory prior to instituting an
anticoagulant treatment. When available, compression ultrasonography (alone or associated with Doppler or color Doppler facilities) should be the preferred initial diagnostic test. However, contrast venography may be necessary before
anticoagulants are withheld because of negative findings on compression ultrasonography.
Pulmonary embolism complicates
upper extremity deep-vein thrombosis in up to 36% of patients and may even be the presenting manifestation of this disorder. Its long-term
clinical course is complicated by recurrent
thromboembolism and post-thrombotic sequelae. Among the therapeutic options advocated for the
therapy of
upper extremity deep-vein thrombosis, unfractionated or
low molecular weight heparin followed by at least 3 months of oral
anticoagulants should be regarded as the treatment of choice. Thrombolysis and
surgical procedures may be indicated in selected cases. The prevention of this disease requires the institution of appropriate pharmacologic measures (i.e., low-dose unfractionated or
low molecular weight heparin or low-dose
warfarin) whenever an indwelling
central venous catheter is indicated. This review suggests that
upper extremity deep-vein thrombosis is at least as serious a disease entity as
deep-vein thrombosis of the lower extremities.