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Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications.
Arch Intern Med. 1997 Jan 13; 157(1):57-62.AI

Abstract

BACKGROUND

Little is known about the clinical, diagnostic, and prognostic aspects of upper-extremity deep vein thrombosis (UEDVT).

OBJECTIVES

To identify the clinical and laboratory parameters associated with this disease, to assess the diagnostic accuracy of ultrasonographic methods for its detection, and to establish the frequency of both early and late complications.

PATIENTS AND METHODS

After a careful history was taken, 58 consecutive patients with signs and symptoms that were clinically suggestive of UEDVT underwent the determination of antithrombin III and protein C and S levels and resistance to activated protein C and lupuslike anticoagulants. Compression ultrasonography, color flow Doppler imaging, and Doppler ultrasonography were performed prior to venography. Patients with confirmed UEDVT underwent objective tests to detect a pulmonary embolism and were followed up prospectively to record recurrent thromboembolic events and postthrombotic sequelae.

RESULTS

Findings from venography confirmed UEDVT in 27 patients (47%). Central venous catheters, thrombophilic states, and a previous leg vein thrombosis were statistically significantly associated with UEDVT. Sensitivity and specificity of compression ultrasonography (96% and 93.5%, respectively) and color flow Doppler imaging (100% and 93%, respectively) were comparable and better than those of Doppler ultrasonography (81% and 77%, respectively). Objective findings suggestive of a pulmonary embolism were recorded in 36% of the patients with UEDVT. After a mean follow-up of 2 years, 2 patients with UEDVT experienced recurrent thromboembolic events, and 4 had postthrombotic sequelae.

CONCLUSIONS

Symptomatic UEDVT is associated with central venous catheters, thrombophilic states, and a previous leg vein thrombosis. Both compression ultrasonography and color flow Doppler imaging are accurate methods for its detection. A pulmonary embolism is a common complication of the disease. Finally, this disorder may recur and may be followed by postthrombotic sequelae.

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Authors+Show Affiliations

Prandoni P
Institute of Medical Semeiotics, University Hospital of Padua, Italy.
Polistena P
No affiliation info available
Bernardi E
No affiliation info available
Cogo A
No affiliation info available
Casara D
No affiliation info available
Verlato F
No affiliation info available
Angelini F
No affiliation info available
Simioni P
No affiliation info available
Signorini GP
No affiliation info available
Benedetti L
No affiliation info available
Girolami A
No affiliation info available

MeSH

AdultAgedArmFemaleHumansMaleMiddle AgedPhlebographyPredictive Value of TestsPrevalencePulmonary EmbolismRisk FactorsSensitivity and SpecificityThrombophlebitisUltrasonographyUltrasonography, DopplerUltrasonography, Doppler, Color

Pub Type(s)

Journal Article

Language

eng

PubMed ID

8996041

Citation

Prandoni, P, et al. "Upper-extremity Deep Vein Thrombosis. Risk Factors, Diagnosis, and Complications." Archives of Internal Medicine, vol. 157, no. 1, 1997, pp. 57-62.
Prandoni P, Polistena P, Bernardi E, et al. Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications. Arch Intern Med. 1997;157(1):57-62.
Prandoni, P., Polistena, P., Bernardi, E., Cogo, A., Casara, D., Verlato, F., Angelini, F., Simioni, P., Signorini, G. P., Benedetti, L., & Girolami, A. (1997). Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications. Archives of Internal Medicine, 157(1), 57-62.
Prandoni P, et al. Upper-extremity Deep Vein Thrombosis. Risk Factors, Diagnosis, and Complications. Arch Intern Med. 1997 Jan 13;157(1):57-62. PubMed PMID: 8996041.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications. AU - Prandoni,P, AU - Polistena,P, AU - Bernardi,E, AU - Cogo,A, AU - Casara,D, AU - Verlato,F, AU - Angelini,F, AU - Simioni,P, AU - Signorini,G P, AU - Benedetti,L, AU - Girolami,A, PY - 1997/1/13/pubmed PY - 1997/1/13/medline PY - 1997/1/13/entrez SP - 57 EP - 62 JF - Archives of internal medicine JO - Arch Intern Med VL - 157 IS - 1 N2 - BACKGROUND: Little is known about the clinical, diagnostic, and prognostic aspects of upper-extremity deep vein thrombosis (UEDVT). OBJECTIVES: To identify the clinical and laboratory parameters associated with this disease, to assess the diagnostic accuracy of ultrasonographic methods for its detection, and to establish the frequency of both early and late complications. PATIENTS AND METHODS: After a careful history was taken, 58 consecutive patients with signs and symptoms that were clinically suggestive of UEDVT underwent the determination of antithrombin III and protein C and S levels and resistance to activated protein C and lupuslike anticoagulants. Compression ultrasonography, color flow Doppler imaging, and Doppler ultrasonography were performed prior to venography. Patients with confirmed UEDVT underwent objective tests to detect a pulmonary embolism and were followed up prospectively to record recurrent thromboembolic events and postthrombotic sequelae. RESULTS: Findings from venography confirmed UEDVT in 27 patients (47%). Central venous catheters, thrombophilic states, and a previous leg vein thrombosis were statistically significantly associated with UEDVT. Sensitivity and specificity of compression ultrasonography (96% and 93.5%, respectively) and color flow Doppler imaging (100% and 93%, respectively) were comparable and better than those of Doppler ultrasonography (81% and 77%, respectively). Objective findings suggestive of a pulmonary embolism were recorded in 36% of the patients with UEDVT. After a mean follow-up of 2 years, 2 patients with UEDVT experienced recurrent thromboembolic events, and 4 had postthrombotic sequelae. CONCLUSIONS: Symptomatic UEDVT is associated with central venous catheters, thrombophilic states, and a previous leg vein thrombosis. Both compression ultrasonography and color flow Doppler imaging are accurate methods for its detection. A pulmonary embolism is a common complication of the disease. Finally, this disorder may recur and may be followed by postthrombotic sequelae. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/8996041/Upper_extremity_deep_vein_thrombosis__Risk_factors_diagnosis_and_complications_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/vol/157/pg/57 DB - PRIME DP - Unbound Medicine ER -