Upper Extremity Deep Venous Thrombosis

Abstract

Purpose: Although much attention has been focused on lower extremity deep venous thrombosis (LEDVT), there is a relative paucity of data regarding upper extremity deep venous thrombosis (UEDVT). While previous literature has suggested that UEDVT is a benign self-limited process with little risk of pulmonary embolism, we noted a significant associated mortality and incidence of pulmonary embolism. To increase our knowledge with the patho logy of UEDVT, we have reviewed our experience.

Methods: Over the last five years, 170 patients have been diagnosed with acute UEDVT by duplex scanning at our institution. These patients were examined to investigate their incidence of pulmonary embolism and their associated mor tality. To compare UEDVT and LEDVT with respect to pulmonary embolism and mortality, we have reviewed records and performed interviews of 430 patients with LEDVT and 52 patients with UEDVT presenting to our institu tion between January 1994 and June 1995. Finally, to investigate the incidence of the hypercoaguable state in UEDVT patients, 52 patients who presented with UEDVT from August 1996 to June 1997 underwent a hematological pro file consisting of activated protein C (APC) resistance, antithrombin III (ATIII) level and activity, factor V mutation (Leiden), protein C level and activity, protein S level and activity, factors II and X activity, lupus anticoagu lant, and cardiolipin antibody.

Results: The 1 month and 3 month mortality rates for the group of 170 patients were 16% and 34%, respectively. Pulmonary embolism was documented by ventilation/perfusion scan in 12 patients (7%). When the 52 UEDVT and 430 LEDVT patients were compared, pulmonary embolism was documented by ven tilation/perfusion lung scan in 9 of 52 patients (17%) with UEDVT and 33 of 430 patients (8%) with LEDVT (p <0.05). Twenty-five of the UEDVT patients (48%) died within 6 months of the diagnosis. Conversely, 14 patients (13%) in the LEDVT group died within 6 months of the diagnosis of LEDVT (p <0.0002). In the group that was studied for a hypercoagulable state, 29 of the 52 patients (56%) with one set of tests were found to have a hypercoagulable state. Seventeen of the 29 patients (58%) who underwent repeat testing twice were found to have a hypercoagulable state.

Conclusions: Contrary to previous reports, these data suggest that UEDVT is associated with a significant incidence of pulmonary embolism and rate of mortality. This review suggests that UEDVT is a more serious entity than pre viously reported and should be managed as aggressively as LEDVT. Finally, UEDVT does seem to be associated with a hypercoagulable state.