CV

Deep Vein Thrombosis of the Upper Extremity

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Deep Vein Thrombosis of the Upper Extremity, Upper Extremity DVT, PICC Line Thrombosis

  • Epidemiology
  1. Patients tend to be younger and of leaner body habitus than those with lower extremity DVT
  • Causes
  1. Central Venous Catheter (common)
  2. PICC Line Thrombosis (complicates 3-5% of PICC Lines)
  3. External Vein Compression (Effort Thrombosis)
    1. Athletes with muscle hypertrophy
  4. Idiopathic (uncommon)
    1. Evaluate for occult cancer (more likely than with lower extremity DVT)
    2. Consider evaluation for Hypercoagulable state
  • Symptoms
  1. Shoulder or Neck Pain
  2. Edema of the hand or arm
  • Signs
  1. Arm with palpable cord
  2. Supraclavicular fullness
  3. Cyanosis of extremity
  4. Serous drainage from PICC Line insertion site
  5. Venous distention
    1. Superficial vein distention
    2. Jugular Venous Distention
  • Differential Diagnosis
  • Imaging
  1. Duplex Ultrasound of upper extremity
  • Management
  1. Anticoagulation
    1. See Anticoagulation in Thromboembolism
    2. Duration: 3-6 months
  2. Consider catheter directed Thrombolysis
  1. PICC Line venous thrombosis risk: 2.5%
    1. May present as serous drainage from the PICC insertion site
  2. New Recommendations
    1. PICC Line does not need to be removed in most Upper Extremity DVTs (if functional and ongoing need)
    2. Anticoagulate for 3 months regardless of presence of cancer (or as long as PICC in place if longer than 3 months)
    3. Older recommendations were to remove the PICC Line and not replacing (even if placed on opposite side)
  3. References
    1. (2012) Chest 141(2): e419S-e494S [PubMed]
    2. DeLoughery and Orman in Majoewsky (2012) EM:Rap 12(12): 4-5
    3. Jones (2010) J Vasc Surg 51(1):108-13 [PubMed]
  • Complications
  1. Pulmonary Embolism (6% of cases; contrast with lower extremity DVT related PE of 33%)
  2. Superior Vena Cava Syndrome