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Upper Extremity Deep Venous Thrombosis (UEDVT)

Samer Badr

Upper extremity Deep Venous Thrombosis (UEDVT) is frequent in the hospital, especially in the intensive careunit. It often complicates the placement of central venous catheters (CVC), notably peripherally inserted central(PICC) lines. Despite a lower rate of pulmonary embolism, UEDVT is as fatal as lower extremity DVT. This is due to its strong association with cancer. Symptoms are often absent, but systematic screening is not recommended. The best prophylaxis is good central catheter management. Pharmacological prophylaxis has questionable effectiveness in the prophylaxis of CVC-associated UEDVT. Compression ultrasonography is the first line diagnostic tool.
Treatment is anticoagulation for at least 3 months. A causative central line should be removed as soon as clinically possible. Infrequently, patients with the thoracic outlet syndrome can get an effort related primary UEDVT. It is also known as the Paget-Schroetter syndrome. Along with anticoagulation, surgical referral for decompression of the thoracic outlet is then necessary. The current state of evidence on UEDVT is rather poor, due to the absence of large randomized controlled trials.