Upper-extremity deep vein thrombosis: A retrospective cohort study of 52 cases

Abstract

Objective: To review the predisposing factors and the evolution of upper-extremity deep vein thrombosis in a series of cases. Methods: Fifty-two consecutive patients (29 men and 23 women, mean age of 52.3 years) with upper-extremity deep vein thrombosis documented by duplex scan (71.1%), phlebography (11.1%) or clinically (15.6%) were included in the study. Results: Clinical manifestations were: forearm pain (24 cases - 46.1%), arm pain (27 cases - 51.9%), upper limb edema (45 cases - 86.5%), pain to arm compression (36 cases - 70.2%) and to arm movement (32 cases - 61.7%). Main risk factors were: vein puncture (20 cases - 39.1%), and cancer (16 cases - 32.6%). Deep vein thrombosis involved humeral (n = 18), axillary (n = 27), subclavian (n = 15) and jugular (n = 11) veins. Pulmonary embolism was initially present in four cases (7.6%). Initial therapy included unfractionated heparin, intravenous (64.3%), subcutaneous (16.7%) or low molecular weight heparin (17.1%) administration, followed by warfarin. Twelve patients died before discharge from the hospital, due to causes not related to pulmonary embolism. The remaining 40 patients were followed-up for a period of 3 months to 10 years. Two died of causes not related to pulmonary embolism, one developed post-thrombotic sequels, such as residual edema and limitations to upper limb movement, and six had discrete residual symptoms (edema and pain). Conclusions: Upper-extremity deep vein thrombosis was more frequent in patients submitted to venous access and with active neoplasia. The outcome of patients exclusively treated with oral anticoagulant was at least similar to other treatments proposed in the literature. Copyright © 2005 by Sociedade Brasileira de Angiologia e Cirurgia Vascular.