Upper extremity deep vein thrombosis: An intensivist’s perspective

Abstract

Upper extremity deep vein thrombosis (UEDVT) is less common than lower extremity DVT but is a cause of significant morbidity and mortality in intensive care unit patients. Increasing cancer incidence, prolonged life expectancy and increasing use of intravascular catheters and devices has led to an increased incidence of UEDVT. It is also associated with high rates of complications like pulmonary embolism, post-thrombotic syndrome and recurrent thrombosis. Clinical prediction scores and D-dimer may not be as useful in identifying UEDVT; hence, a high suspicion index is required for diagnosis. Doppler ultrasound is commonly employed for diagnosis, but other tests like computed tomography and magnetic resonance imaging venography may also be required in some patients. Contrast venography is rarely used in patients with clinical and ultrasound findings discrepancies. Anticoagulant therapy alone is sufficient in most patients, and thrombolysis and surgical decompression is seldom indicated. The outcome depends on the cause and underlying comorbidities.

Keywords: Catheter associated deep vein thrombosis; Pacemaker associated deep vein thrombosis; Paget-von Schröetter syndrome; Thoracic outlet syndrome; Upper extremity deep vein thrombosis

Core Tip: Upper extremity deep vein thrombosis (UEDVT), is largely under-recognised and an often missed diagnosis. Even though it is less common than the lower extremity DVT, it is increasingly being diagnosed, especially in intensive care unit patients because of presence of venous catheters and devices in these patients. Traditionally used clinical probability scores and tests like D-dimer may not be as effective in diagnosing UEDVT. Bedside Doppler ultrasound is the most commonly employed diagnostic tool which may aid in clinching the diagnosis. Contrast venography remains the gold standard, but is rarely required. Pulmonary embolism is the most dreaded complication but the rates of other complications including post thrombotic syndrome and recurrent DVT also remain significant. Anticoagulant therapy alone is sufficient in most patients. However, UEDVT may be associated with high mortality rates unless early diagnostic and therapeutic measures are initiated.