Upper extremity deep venous thrombosis: 40 hospitalized patients.

Deep venous thrombosis is 50 times less frequent in upper than in lower lim bs. Data remain poor in the literature. Forty consecutive patients (24 male s, 16 females, mean age: 54.5 years) were retrospectively analysed from 161 subjects who underwent venous explorations of the upper extremity for a 3. 5 year period in the same center. Diagnosis of thrombosis was made by duple x ultrasonography (n = 37) or phlebography (n = 3). Main clinical manifesta tions were edema (n = 56) and pain (n = 29). Location of thrombosis was hum eral (n = 1), axillary (n = 2), or sub-clavian (n = 37, 2 bilateral). The m ajority of thrombosis (n = 29) were secondary to cancer and venous catheter (n= 19, 15 implanted ports), to central catheter alone in = 3) or cancer a lone (n = 7). The 11 others were associated with thoracic outlet syndrome ( n=6) or apparent primary thrombosis (n=5). Thrombophilia was identified in 6 out of these 11. During follow up [mean of 9 months (0,5-36)], two patien ts developed pulmonary embolism, 14 a post-thrombotic syndrome and 16 patie nts died. Initial therapy included heparin (n=36) or fibrinolysis (n=4). Up per extremity deep venous thrombosis are mostly associated with cancers and venous catheters. Thrombophilia is frequent in the other cases. Heparin fo llowed by oral anticoagulation is the optimal therapy whose duration depend s upon underlying condition. Fibrinolysis has not been useful for preventin g post-thrombotic syndrome in our study.