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Semin intervent Radiol 2022; 39(05): 475-482
DOI: 10.1055/s-0042-1757937
Review Article

Upper Extremity Deep Venous Thrombosis: Etiologies, Diagnosis, and Updates in Therapeutic Strategies

Yilun Koethe
1   Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
,
Teodora Bochnakova
1   Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
,
Claire S. Kaufman
1   Dotter Department of Interventional Radiology, Oregon Health & Sciences University, Portland, Oregon
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Abstract

Upper extremity deep vein thrombosis (UEDVT) is responsible for 4 to 10% of all deep vein thrombosis (DVT). Untreated UEDVT can lead to significant disability secondary to the postthrombotic syndrome. To date, there are no randomized trials specifically comparing different therapeutic strategies. Ultimately, optimal management of UEDVT depends on the underlying etiology, patient symptoms, and degree of thrombosis, with supporting evidence primarily extrapolated from lower extremity DVT data. This article will review the classification, presentation, and diagnosis of both primary and secondary UEDVT. In addition, it will discuss updates in clinical guidelines, anticoagulation, endovascular and surgical treatment strategies.

Keywords

upper extremity deep vein thrombosis - postthrombotic syndrome - endovenous catheter-directed therapy - venous thoracic outlet syndrome


Publication History

Article published online:
20 December 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Isma N, Svensson PJ, Gottsäter A, Lindblad B. Upper extremity deep venous thrombosis in the population-based Malmö thrombophilia study (MATS). Epidemiology, risk factors, recurrence risk, and mortality. Thromb Res 2010; 125 (06) e335-e338
    CrossrefPubMedGoogle Scholar
  • 2 Engelberger RP, Kucher N. Management of deep vein thrombosis of the upper extremity. Circulation 2012; 126 (06) 768-773
    CrossrefPubMedGoogle Scholar
  • 3 Modi BP, Chewning R, Kumar R. Venous thoracic outlet syndrome and Paget-Schroetter syndrome. Semin Pediatr Surg 2021; 30 (06) 151125
    CrossrefPubMedGoogle Scholar
  • 4 Hendler MF, Meschengieser SS, Blanco AN. et al. Primary upper-extremity deep vein thrombosis: high prevalence of thrombophilic defects. Am J Hematol 2004; 76 (04) 330-337
    CrossrefPubMedGoogle Scholar
  • 5 Kucher N. Clinical practice. Deep-vein thrombosis of the upper extremities. N Engl J Med 2011; 364 (09) 861-869
    CrossrefPubMedGoogle Scholar
  • 6 Winters JP, Callas PW, Cushman M, Repp AB, Zakai NA. Central venous catheters and upper extremity deep vein thrombosis in medical inpatients: the Medical Inpatients and Thrombosis (MITH) Study. J Thromb Haemost 2015; 13 (12) 2155-2160
    CrossrefPubMedGoogle Scholar
  • 7 Luciani A, Clement O, Halimi P. et al. Catheter-related upper extremity deep venous thrombosis in cancer patients: a prospective study based on Doppler US. Radiology 2001; 220 (03) 655-660
    CrossrefPubMedGoogle Scholar
  • 8 Duijzer D, de Winter MA, Nijkeuter M, Tuinenburg AE, Westerink J. Upper extremity deep vein thrombosis and asymptomatic vein occlusion in patients with transvenous leads: a systematic review and meta-analysis. Front Cardiovasc Med 2021; 8: 698336
    CrossrefPubMedGoogle Scholar
  • 9 Joffe HV, Kucher N, Tapson VF, Goldhaber SZ, Deep Vein Thrombosis FSC. Deep Vein Thrombosis (DVT) FREE Steering Committee. Upper-extremity deep vein thrombosis: a prospective registry of 592 patients. Circulation 2004; 110 (12) 1605-1611
    CrossrefPubMedGoogle Scholar
  • 10 Paauw JD, Borders H, Ingalls N. et al. The incidence of PICC line-associated thrombosis with and without the use of prophylactic anticoagulants. JPEN J Parenter Enteral Nutr 2008; 32 (04) 443-447
    CrossrefPubMedGoogle Scholar
  • 11 Sanders RJ, Hammond SL, Rao NM. Diagnosis of thoracic outlet syndrome. J Vasc Surg 2007; 46 (03) 601-604
    CrossrefPubMedGoogle Scholar
  • 12 Lee JB, Kurzweil A, Lahham S. A case report on Paget-Schroetter syndrome presenting as acute localized rhabdomyolysis. Clin Pract Cases Emerg Med 2020; 4 (03) 358-361
    CrossrefPubMedGoogle Scholar
  • 13 Muñoz FJ, Mismetti P, Poggio R. et al; RIETE Investigators. Clinical outcome of patients with upper-extremity deep vein thrombosis: results from the RIETE Registry. Chest 2008; 133 (01) 143-148
    CrossrefPubMedGoogle Scholar
  • 14 Levy MM, Albuquerque F, Pfeifer JD. Low incidence of pulmonary embolism associated with upper-extremity deep venous thrombosis. Ann Vasc Surg 2012; 26 (07) 964-972
    CrossrefPubMedGoogle Scholar
  • 15 Houghton DE, Billett HH, Gaddh M. et al. Risk of pulmonary emboli after removal of an upper extremity central catheter associated with a deep vein thrombosis. Blood Adv 2021; 5 (14) 2807-2812
    CrossrefPubMedGoogle Scholar
  • 16 Elman EE, Kahn SR. The post-thrombotic syndrome after upper extremity deep venous thrombosis in adults: a systematic review. Thromb Res 2006; 117 (06) 609-614
    CrossrefPubMedGoogle Scholar
  • 17 Thiyagarajah K, Ellingwood L, Endres K. et al. Post-thrombotic syndrome and recurrent thromboembolism in patients with upper extremity deep vein thrombosis: a systematic review and meta-analysis. Thromb Res 2019; 174: 34-39
    CrossrefPubMedGoogle Scholar
  • 18 Desjardins B, Hanley M, Steigner ML. et al; Expert Panel on Vascular Imaging. ACR Appropriateness Criteria® suspected upper extremity deep vein thrombosis. J Am Coll Radiol 2020; 17 (5S): S315-S322
    CrossrefPubMedGoogle Scholar
  • 19 van Dam LF, Dronkers CEA, Gautam G. et al; Theia Study Group. Magnetic resonance imaging for diagnosis of recurrent ipsilateral deep vein thrombosis. Blood 2020; 135 (16) 1377-1385
    Google Scholar
  • 20 Kearon C, Akl EA, Ornelas J. et al. Antithrombotic therapy for VTE disease: CHEST Guideline and Expert Panel Report. Chest 2016; 149 (02) 315-352
    CrossrefPubMedGoogle Scholar
  • 21 Stevens SM, Woller SC, Kreuziger LB. et al. Antithrombotic therapy for VTE disease: second update of the CHEST Guideline and Expert Panel Report. Chest 2021; 160 (06) e545-e608
    CrossrefPubMedGoogle Scholar
  • 22 Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK. Paget-Schroetter syndrome: review of pathogenesis and treatment of effort thrombosis. West J Emerg Med 2010; 11 (04) 358-362
    PubMedGoogle Scholar
  • 23 AbuRahma AF, Sadler D, Stuart P, Khan MZ, Boland JP. Conventional versus thrombolytic therapy in spontaneous (effort) axillary-subclavian vein thrombosis. Am J Surg 1991; 161 (04) 459-465
    CrossrefPubMedGoogle Scholar
  • 24 Aburahma AF, Sadler DL, Robinson PA. Axillary subclavian vein thrombosis. Changing patterns of etiology, diagnostic, and therapeutic modalities. Am Surg 1991; 57 (02) 101-107
    PubMedGoogle Scholar
  • 25 Lee WA, Hill BB, Harris Jr EJ, Semba CP, Olcott C IV. Surgical intervention is not required for all patients with subclavian vein thrombosis. J Vasc Surg 2000; 32 (01) 57-67
    CrossrefPubMedGoogle Scholar
  • 26 Molina JE, Hunter DW, Dietz CA. Protocols for Paget-Schroetter syndrome and late treatment of chronic subclavian vein obstruction. Ann Thorac Surg 2009; 87 (02) 416-422
    CrossrefPubMedGoogle Scholar
  • 27 Edo Fleta G, Torres Blanco Á, Gómez Palonés F, Ortiz Monzón E. Combined non-surgical treatment for Paget-Schröetter syndrome: a case report. J Med Case Reports 2016; 10: 171
    CrossrefPubMedGoogle Scholar
  • 28 Haig Y, Enden T, Grøtta O. et al; CaVenT Study Group. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. Lancet Haematol 2016; 3 (02) e64-e71
    CrossrefPubMedGoogle Scholar
  • 29 Comerota AJ, Kearon C, Gu CS. et al; ATTRACT Trial Investigators. Endovascular thrombus removal for acute iliofemoral deep vein thrombosis. Circulation 2019; 139 (09) 1162-1173
    CrossrefPubMedGoogle Scholar
  • 30 Doyle A, Wolford HY, Davies MG. et al. Management of effort thrombosis of the subclavian vein: today's treatment. Ann Vasc Surg 2007; 21 (06) 723-729
    CrossrefPubMedGoogle Scholar
  • 31 Meier GH, Pollak JS, Rosenblatt M, Dickey KW, Gusberg RJ. Initial experience with venous stents in exertional axillary-subclavian vein thrombosis. J Vasc Surg 1996; 24 (06) 974-981 , discussion 981–983
    CrossrefPubMedGoogle Scholar
  • 32 Kärkkäinen JM, Nuutinen H, Riekkinen T. et al. Pharmacomechanical thrombectomy in Paget-Schroetter syndrome. Cardiovasc Intervent Radiol 2016; 39 (09) 1272-1279
    CrossrefPubMedGoogle Scholar
  • 33 Singh A, Kaur M, Singh A, Bhatti A, Patel R. Paget-Schroetter syndrome (PSS) and adjunctive treatment with mechanical aspiration thrombectomy and catheter directed thrombolysis: a case report and review of literature. Cureus 2022; 14 (04) e24437
    PubMedGoogle Scholar
  • 34 Sýkora J, Zeleňák K, Vorčák M. et al. Percutaneous thrombectomy in the management of early rethrombosis in venous thoracic outlet syndrome: two case reports. CVIR Endovasc 2021; 4 (01) 61
    CrossrefPubMedGoogle Scholar
  • 35 Bayer O, Schummer C, Richter K, Fröber R, Schummer W. Implication of the anatomy of the pericardial reflection on positioning of central venous catheters. J Cardiothorac Vasc Anesth 2006; 20 (06) 777-780
    CrossrefPubMedGoogle Scholar
  • 36 Usoh F, Hingorani A, Ascher E. et al. Long-term follow-up for superior vena cava filter placement. Ann Vasc Surg 2009; 23 (03) 350-354
    CrossrefPubMedGoogle Scholar
  • 37 Owens CA, Bui JT, Knuttinen MG, Gaba RC, Carrillo TC. Pulmonary embolism from upper extremity deep vein thrombosis and the role of superior vena cava filters: a review of the literature. J Vasc Interv Radiol 2010; 21 (06) 779-787
    CrossrefPubMedGoogle Scholar
  • 38 Samoila G, Twine CP, Williams IM. The infraclavicular approach for Paget-Schroetter syndrome. Ann R Coll Surg Engl 2018; 100 (02) 83-91
    CrossrefPubMedGoogle Scholar
  • 39 Suzuki T, Kimura H, Matsumura N, Iwamoto T. Surgical approaches for thoracic outlet syndrome: a review of the literature. Journal of Hand Surgery Global Online 2022
    PubMedGoogle Scholar
  • 40 Elixène JB, Sadaghianloo N, Mousnier A, Brizzi S, Declemy S, Hassen-Khodja R. Long-term functional outcomes and subclavian vein patency in patients undergoing thoracic outlet surgery for Paget-Schroetter syndrome. J Cardiovasc Surg (Torino) 2017; 58 (03) 451-457
    PubMedGoogle Scholar
  • 41 de Kleijn RJCMF, Schropp L, Westerink J, de Borst GJ, Petri BJ. Timing of thoracic outlet decompression after thrombolysis for primary upper extremity deep venous thrombosis: a systematic review. Ann Vasc Surg 2020; 66: 654-661
    CrossrefPubMedGoogle Scholar
  • 42 Silverberg D, Fish M, Lubetsky A. et al. Long-term outcome after nonsurgical management of Paget-Schroetter syndrome. J Vasc Surg Venous Lymphat Disord 2021; 9 (01) 170-177
    CrossrefPubMedGoogle Scholar
  • 43 Peek J, Vos CG, Ünlü Ç, van de Pavoordt HDWM, van den Akker PJ, de Vries JPM. Outcome of surgical treatment for thoracic outlet syndrome: systematic review and meta-analysis. Ann Vasc Surg 2017; 40: 303-326
    CrossrefPubMedGoogle Scholar
  • 44 Lugo J, Tanious A, Armstrong P. et al. Acute Paget-Schroetter syndrome: does the first rib routinely need to be removed after thrombolysis?. Ann Vasc Surg 2015; 29 (06) 1073-1077
    CrossrefPubMedGoogle Scholar
  • 45 Carlon TA, Sudheendra D. Interventional therapy for upper extremity deep vein thrombosis. Semin Intervent Radiol 2017; 34 (01) 54-60
    Article in Thieme ConnectPubMedGoogle Scholar
  • 46 Harmon D, Dabaja W, Qaqi O. A novel interventional approach to upper extremity swelling. J Vasc Surg Cases Innov Tech 2020; 6 (02) 209-211
    CrossrefPubMedGoogle Scholar