Upper extremity vein thrombosis: Etiologic categories, precipitating causes, and management

Although an increasing incidence of upper extremity venous thrombosis (U/E- DVT) has been reported, a relative paucity of information regarding the eti ologic categories, precipitating causes, and proper management for this dis order is available. To settle on a strategy for the management of U/E-DVT, retrospective analyses were performed using records from the authors' hospi tal. In 12 patients (seven men, five women), 61 (mean) years of age, diagno sed as having symptomatic venography-proved U/E-DVT and followed up for 41 (mean) months, etiologic factors, precipitating causes, treatments, and out comes were retrospectively analyzed. As etiologic factors, five of the pati ents had neoplastic disease, one had hemodialysis, and two had transvenous pacemaker implantations. Among various precipitating causes of U/E-DVT, hyp oproteinemia was most frequently noted (67%). Various types of therapeutic management were selected: from thrombolysis with urokinase in six, balloon angioplasty in two, thrombectomy in two, and venous bypass surgery in one p atient. Pulmonary embolism did not occur in any of the patients and only th ree of them complained of mild intermittent arm swelling during the follow- up period. Four patients died of neoplastic disease or heart failure (three within the first 6 months). This study, though limited, suggests that the rate of mortality depends on multiple underlying medical problems in U/E-DVT patients. Low incidences of late postthrombotic sequelae and pulmonary embolism were noted in this ser ies. Symptomatic U/E-DVT patients could be managed conservatively with a re vised supplementary therapy for their precipitating causes of U/E-DVT.