UPPER-EXTREMITY DEEP VENOUS THROMBOSIS - A REPORT OF 49 CASES

Purpose. - Upper-extremity thrombosis appears to be more frequent toda y, comprising about 2% of all deep venous limb thrombosis. Its severit y depends on the type of possible complications, ie, pulmonary embolis m and post-thrombotic sequelae. In this retrospective series, we inves tigated both the predisposing factors and the evolution of upper-extre mity deep venous thrombosis. Methods. - Forty-nine consecutive patient s (24 men and 25 women, mean age 50.2 years) with upper extremity deep venous thrombosis documented by color Doppler ultrasonography (n = 47 ) or phlebography (n = 2) were included in the study.Results, - Clinic al manifestations were mainly pain (81.6%) and edema (93.9%). Mean tim e between the onset of clinical signs and diagnosis was 7.2 days. Thro mbosis involved humeral (26.5%), axillary (46.9%), subclavian (73.5%) and jugular (24.5%) veins. Causative factors were malignancies (32.7%) , venous catheters (22.4%), deep venous thrombosis related to effort o r thoracic outlet syndrome (22.5%) and thrombophilic states (8.2%). Du ring the 6-month follow-up, six patients developed symptomatic pulmona ry embolism (12.2%); one recurrence (2.2%) and 19 post-thrombotic sequ elae such as residual edema (36.7%) were also observed. Initial therap y included heparin administration, principally subcutaneous low molecu lar weight heparins (n = 36/49). Conclusion. - This series highlights the fact that upper-extremity deep venous thrombosis is mainly seconda ry to either malignancies or catheterization. Moreover, it confirms th at color Doppler ultrasonography may be useful in the diagnosis of the disease and also underlines the high frequency of severe complication s, ie, pulmonary embolism and post-thrombotic sequelae. Finally, this study also demonstrates that low molecular weight heparins should be c onsidered as the initial treatment of choice. (C) 1998, Elsevier, Pari s.