Author(s): Marinella MA, Kathula SK, Markert RJ
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Abstract OBJECTIVE: The goal of this study was to characterize the spectrum of upper-extremity deep venous thrombosis in a community teaching hospital. DESIGN AND SETTING: A retrospective analysis was used at a large urban teaching hospital. MATERIAL AND METHODS: We reviewed the records of 90 patients with ultrasound-documented thrombosis of the internal jugular, subclavian, axillary, or brachial veins to determine clinical characteristics, risk factors, and outcome. RESULTS: The most common underlying conditions associated with upper-extremity deep venous thrombosis were the presence of a central venous catheter in 65 patients (72\%), infection in 25 (28\%), extrathoracic malignancy in 20 (22\%), thoracic malignancy in 19 (21\%), renal failure in 19 (21\%), and a prior lower-extremity deep venous thrombosis in 16 (18\%). Pain was noted in 31 (34\%) patients, and 76 patients (84\%) had edema of the involved extremity. The left subclavian vein was involved in 44 patients (49\%), and 35 patients (39\%) had a central venous catheter in the left subclavian vein. When a central venous catheter was present, the deep venous thrombosis was usually ipsilateral (P <.001). Heparin and warfarin were administered to 65 (72\%) and 53 (59\%) of the patients, respectively. Eleven patients (12\%) died. Of these patients, 8 (73\%) had an underlying infection, whereas only 22\% of survivors had an infection (P =.0012). CONCLUSION: Upper-extremity deep venous thrombosis typically occurs in patients with a systemic illness in the presence of a central venous catheter. The left subclavian vein is frequently involved because this is a common site for placement of a central venous catheter. Pain is uncommon, but edema of the involved extremity is noted in the majority of patients. The mortality rate of patients in this study with an upper-extremity deep venous thrombosis was 12\%; most patients who died had a central venous catheter and an underlying infection.
This article was published in Heart Lung
and referenced in Internal Medicine: Open Access