Thursday, October 20, 2011

Upper extremity DVT

Here is a recent review in the American Journal of Medicine.

Some key points:

Deep veins are defined as brachial, acillary, brachiocephalic, IJ and subclavian veins. Basilic, cephalic and EJ are considered superficial.

Secondary UE DVT is the most common presentation, and is usually due to central IV catheters including peripherally inserted (PICCs). Other risk factors such as malignancy are included.

Primary UE DVT is less common and also known as Paget-Schroetter syndrome. It may be precipitated by vigorous arm activity and may be associated with thoracic outlet abnormalities.

The diagnostic approach is similar to that for LE DVT although supporting research data are relatively sparse.

There appears to be a lower incidence of concomitant PE although sequellae are otherwise similar to those of LE DVT.

Treatment, including duration, is similar to that for LE DVT.

Because cosmetic and comfort issues are more likely to surface with UE DVT than for LE DVT, thrombolysis (systemic or regional) or catheter extraction are often considered. However, data are limited and based on the evidence, at present, such techniques are recommended mainly for patients with massive clot burdens.

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