UPPER EXTREMITY DEEP VENOUS THROMBOSIS AND ITS IMPACT ON MORBIDITY AND MORTALITY-RATES IN A HOSPITAL-BASED POPULATION

Purpose: Although much attention has been focused on lower extremity d eep venous thrombosis (LEDVT), there is a relative paucity of data reg arding the impact of upper extremity deep venous thrombosis (UEDVT) on morbidity and mortality rates. To increase our knowledge with the lat ter disease, are have reviewed our experience at our institution with 170 patients who had brachial, axillary, and subclavian vein thrombose s. Methods: Over the past 5 years, UEDVT was diagnosed in 170 patients by duplex scanning. The indications for duplex examination were eithe r upper extremity swelling (95%) or as part of the workup for pulmonar y embolism (5%). There were 103 women (61%) and 67 men (39%), with age s ranging from 9 to 101 years (mean, 68 +/- 17 years). The diagnosis w as made in 152 patients (89%) while they were admitted to the hospital and in 18 patients (11%) in the outpatient clinic. Risk factors inclu ded presence of a central venous catheter or pacemaker in 110 patients (65%), malignancy in 63 patients (37%), concomitant LEDVT in 19 patie nts (11%), and history of LEDVT in 18 patients (11%). Fifty-six patien ts (33%) had multiple risk factors, whereas 36 patients (21%) had no o bvious risk factor. Results: The 1-month and 3-month mortality rates f or the entire study group were 16% and 34%, respectively. Patients who had concomitant LEDVT, were 75 years of age or older, and were not tr eated with anticoagulation medication had a significantly higher 1-mon th mortality rate. Patients whose diagnoses were made in the outpatien t setting were statistically younger and had a lower 3-month mortality rate when compared with the patients whose diagnoses were made as inp atients. Pulmonary embolism was documented by ventilation/perfusion sc an in 12 patients (7%). Although no patient in the group in which UEDV T was diagnosed on an outpatient basis was documented to have a pulmon ary embolism and 12 patients (8%) in the inpatient group had pulmonary emboli, this difference was not statistically significant. Anticoagul ation medication did not totally prevent pulmonary embolism in this re view. Al patients were followed-up for between 0 to 49 months (mean, 1 3 +/- 1 months). No swelling of the affected arm was observed in 145 p atients (94%); four patients complained of mild intermittent swelling (2%), and seven patients reported significant swelling (4%). Conclusio ns: Contrary to previous reports, these data suggest that UEDVT is ass ociated with a low incidence of postthrombotic upper extremity swellin g, but a significant incidence of pulmonary embolism and rate of morta lity. This review suggests that UEDVT is at least as serious a disease entity as LEDVT and should be managed as aggressively as LEDVT.