Two different therapeutic modalities in the treatment of the upper extremity deep vein thrombosis: Preliminary investigation with 20 case reports

Abstract

Primary or secondary axillary or/and subclavian vein thrombosis (ASVT) can produce long-term disability, mostly in young patients, while the final vein recanalization after various therapeutic modalities often fails. Our aim was to compare the results of two different therapeutic modalities: the thrombolytic vs anticoagulant therapy, in primary and secondary ASVT in a retrospective data analysis in terms of efficacy, negative side effects, long-term positive results. Eleven patients (Group A), with primary and secondary to central venous cannulation or cardiac pacing ASVT, were treated with anticoagulant therapy, while another 9 patients (Group B), were treated with thrombolytic therapy, that included urokinase or streptokinase for 24–48 hours. The phlebographic, duplex ultrasonographic findings and clinical improvement were compared between the two patient groups. In Group A patients, after a mean period of 81.7 months follow-up (range 58–106), one patient with open vein were noticed, while in Group B patients after a mean follow up period of 52.1 months (range 35–68) five patients presented with recanalized veins (P=0.040). Complete clinical recovery and vein patency was achieved in one Group A patient, contrary to 5 Group B patients (P=0.040). When the patients with complete clinical recovery were combined with those who presented some clinical improvement, four Group A patients and eight Group B had satisfactory outcome (P=0.028). Thrombolytic therapy should be the treatment of choice in primary and secondary ASVT, in productive patients whose lifestyle depends on continued strenuous use of the involved limb with a reasonable medium-term life expectancy. The thrombolytic agents prevent the vein valves damage and malfunction, avoiding re-thrombosis related to venous reflux and stasis, preserving the valve functional integrity.