Spectrum of upper-extremity deep venous thrombosis in a community teachinghospital

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 teac hing hospital. MATERIAL AND METHODS: We reviewed the records of 90 patients with ultrasoun d-documented thrombosis of the internal jugular, subclavian, axillary, or b rachial veins to determine clinical characteristics, risk factors, and outc ome. RESULTS: The most common underlying conditions associated with upper-extrem ity deep venous thrombosis were the presence of a central venous catheter i n 65 patients (72%), infection in 25 (28%), extrathoracic malignancy in 20 (22%), thoracic malignancy in 19 (21%), renal failure in 19 (21%), and a pr ies lower-extremity deep venous thrombosis in 16 (18%). Pain was noted in 3 1 (34%) patients, and 76 patients (84%) had edema of the involved extremity . The left subclavian vein was involved in 44 patients (49%), and 35 patien ts (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 s urvivors had an infection (P = .0012). CONCLUSION: Upper-extremity deep venous thrombosis typically occurs in pati ents with a systemic illness in the presence of a central venous catheter. The left subclavian vein is frequently involved because this is a common si te for placement of a central venous catheter. Pain is uncommon, but edema of the involved extremity is noted in the majority of patients. The mortali ty rate of patients in this study with an upper-extremity deep venous throm bosis was 12%; most patients who died had a central venous catheter and an underlying infection.