UMEM Educational Pearls

Title: Upper Extremity Deep Vein Thrombosis (UEDVT)

Posted: 9/3/2013 by Haney Mallemat, MD
Click here to contact Haney Mallemat, MD

UEDVT comprise 10% of all DVTs (majority are lower extremity), but incidence of UEDVT is rising; UEDVTs are categorized into distal (veins distal to axillary vein) or proximal (from superior vena cava to axillary vein)

Compared to lower extremity DVT, UEDVTs have lower:

mortality
risk of pulmonary embolism
rates of recurrence

75% of UEDVT are secondary (indwelling catheters, pacemakers, malignancy, etc.) and 25% are primary in nature; #1 primary cause of UEDVT is Paget – Schroetter disease

Up to 25% of patients with primary UEDVTs are eventually found to have an underlying malignancy; patients with idiopathic UEDVT should be referred for cancer workup

Treatment includes removal of the catheter (if no longer needed) and:

anticoagulation (minimum of 3 months)
consideration of thrombolytics, including catheter-directed administration
mechanical thrombolysis (clot aspiration, fragmentation, etc.)
surgical thrombectomy / venous bypass

References

Follow me on Twitter (@criticalcarenow) or Google+ (+criticalcarenow)