Prospective Evaluation of Combined Upper and Lower Extremity DVT

Abstract

The clinical importance of upper extremity deep venous thrombosis (UEDVT) has been increasingly demonstrated in recent literature. Not only has the risk of pulmonary embolism from isolated upper extremity DVT been demonstrated, but a significant associated mortality has been encountered. Examination of this group of patients has demonstrated the existence of combined upper and lower extremity deep venous thrombosis (DVT) in some patients who exhibit an even higher associated mortality. As a result of this information, it has become the standard practice at this institution to search for lower extremity DVTs in patients found to have acute thrombosis of upper extremity veins. Since January 1999, there have been a total of 227 patients diagnosed with acute UEDVT. Within this group, 211 (93%) patients had lower extremity studies; 45 of these 211 (21%) had acute lower extremity DVTs by duplex examination in addition to the upper extremity DVTs. Overall, there were 145 women, 66 men, and the average age was 70 ±1.2 (SEM); 22 of these patients had bilateral lower extremity thrombosis (LEDVT), and 8 patients were found to have chronic thrombosis of lower extremity veins. Of the patients with bilateral upper extremity DVTs, there were 3 with bilateral LE acute DVTs. Finally, 8 of the remaining 166 patients (5%) with originally negative lower extremity studies were found to develop a thrombosis at a later date. These data serve to confirm previous studies, on a larger scale, that there should be a high index of suspicion in patients with UEDVT of a coexistent LEDVT.

Get full access to this article

View all access options for this article.

References

Shah MK , Burke DT , Shah SH : Upper-extremity deep vein thrombosis. South Med J 96:669-672, 2003.

Kommareddy A , Zaroukian MH , Hassouna HI : Upper extremity deep venous thrombosis. Semin Thromb Hemost 28:89-99, 2002.

Saleem A , Markel DC : Fatal pulmonary embolus after shoulder arthroplasty. J Arthroplasty 16:400-403, 2001.

Walper JJ , Markel DC : Upper extremity deep venous thrombosis leading to pulmonary embolism after total hip arthroplasty. J Arthroplasty 16:124-127, 2001.

Prandoni P , Bernardi E : Upper extremity deep vein thrombosis. Curr Opin Pulm Med 5:222-226, 1999.

Prandoni P , Polistena P , Bernardi E , et al: Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications. Arch Intern Med 157:57-62, 1997.

Gomes MR , Tomaso H , Nazarian GK , et al: Upper-extremity deep vein thrombosis and chronic pulmonary embolism resulting in pulmonary artery hypertension. Am J Roentgenol 170:1532-1534, 1998.

Kooij JD , van der Zant FM , van Beek EJ , et al: Pulmonary embolism in deep venous thrombosis of the upper extremity: More often in catheter-related thrombosis. Neth J Med 50:238-242, 1997.

Black MD , French GJ , Rasuli P , et al: Upper extremity deep venous thrombosis. Underdiagnosed and potentially lethal. Chest 103:1887-1890, 1993.

10.

Monreal M , Lafoz E , Ruiz J , et al: Upper-extremity deep venous thrombosis and pulmonary embolism. A prospective study. Chest 99:280-283, 1991.

11.

Horattas MC , Wright DJ , Fenton AH , et al: Changing concepts of deep venous thrombosis of the upper extremity—report of a series and review of the literature. Surgery 104:561-567, 1988.

12.

Marinella MA , Kathula SK , Markert RJ : Spectrum of upper-extremity deep venous thrombosis in a community teaching hospital. Heart Lung 29:113-117, 2000.

13.

Ascher E , Hingorani A , Mazzariol F , et al: Clinical experience with superior vena caval Greenfield filters. J Endovasc Surg 6:365-369, 1999.

14.

Ascher E , Hingorani A , Tsemekhin B , et al: Lessons learned from a 6-year clinical experience with superior vena cava Greenfield filters. J Vasc Surg 32:881-887, 2000.

15.

Hingorani A , Ascher E , Ward M , et al: Combined upper and lower extremity deep venous thrombosis. Cardiovasc Surg 9:472-477, 2001.

16.

Hingorani A , Ascher E , Hanson J , et al: Upper extremity versus lower extremity deep venous thrombosis. Am J Surg 174:214-217, 1997.

17.

Hingorani A , Ascher E , Lorenson E , et al: Upper extremity deep venous thrombosis and its impact on morbidity and mortality rates in a hospital-based population. J Vasc Surg 26:853-860, 1997.

18.

Hingorani A , Ascher E , Yorkovich W , et al: Upper extremity deep venous thrombosis: An underrecognized manifestation of a hypercoagulable state. Ann Vasc Surg 14:421-426, 2000.

19.

Leebeek FW , Stadhouders NA , van Stein D , et al: Hypercoagulability states in upper-extremity deep venous thrombosis. Am J Hematol 67:15-19, 2001.

20.

Heron E , Lozinguez O , Alhenc-Gelas M , et al: Hyper-coagulable states in primary upper-extremity deep vein thrombosis. Arch Intern Med 160:382-386, 2000.

21.

Girolami A , Prandoni P , Zanon E , et al: Venous thromboses of upper limbs are more frequently associated with occult cancer as compared with those of lower limbs. Blood Coagul Fibrinolysis 10:455-457, 1999.

22.

Bernardi E , Piccioli A , Marchiori A , et al: Upper extremity deep vein thrombosis: Risk factors, diagnosis, and management. Semin Vasc Med 1:105-110, 2001.