[Deep venous thrombosis of the upper limbs. Apropos of 49 cases].
OBJECTIVE
Upper-extremity thrombosis appears to be more frequent today, comprising about 2% of all deep venous limb thrombosis. Its severity depends on the type of possible complications, i.e., pulmonary embolism and post-thrombotic sequelae. In this retrospective series, we investigated both the predisposing factors and the evolution of upper-extremity deep venous thrombosis.


METHODS
Forty-nine consecutive patients (24 men and 25 women, mean age 50.2 years) with upper extremity deep venous thrombosis documented by color Doppler ultrasonography (n = 47) or phlebography (n = 2) were included in the study.


RESULTS
Clinical manifestations were mainly pain (81.6%) and edema (93.9%). Mean time between the onset of clinical signs and diagnosis was 7.2 days. Thrombosis involved humeral (26.5%), axillary (46.9%), subclavian (73.5%) and jugular (24.5%) veins. Causative factors were malignancies (32.7%), venous catheters (22.4%), deep venous thrombosis related to effort or thoracic outlet syndrome (22.5%) and thrombophilic states (8.2%). During the 6-month follow-up, six patients developed symptomatic pulmonary embolism (12.2%); one recurrence (2.2%) and 19 post-thrombotic sequelae such as residual edema (36.7%) were also observed. Initial therapy included heparin administration, principally subcutaneous low molecular weight heparins (n = 36/49).


CONCLUSIONS
This series highlights the fact that upper-extremity deep venous thrombosis is mainly secondary to either malignancies or catheterization. Moreover, it confirms that color Doppler ultrasonography may be useful in the diagnosis of the disease and also underlines the high frequency of severe complications, i.e., pulmonary embolism and post-thrombotic sequelae. Finally, this study also demonstrates that low molecular weight heparins should be considered as the initial treatment of choice.
Département de médecine interne, Centre Hospitalier Universitaire de Rouen-Boisguillaume, France.
I
I
Marie
H
H
Lévesque
N
N
Cailleux
E
E
Primard
C
C
Peillon
J
J
Watelet
H
H
Courtois
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001132:Arm / Q000098:blood supply* / Q000000981:diagnostic imaging; D001367:Axillary Vein / Q000000981:diagnostic imaging; D002405:Catheterization, Central Venous / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D006811:Humerus / Q000098:blood supply; D007601:Jugular Veins / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D010689:Phlebitis / Q000150:complications; D010690:Phlebography; D011186:Postphlebitic Syndrome / Q000209:etiology; D011655:Pulmonary Embolism / Q000209:etiology; D012189:Retrospective Studies; D013350:Subclavian Vein / Q000000981:diagnostic imaging; D013901:Thoracic Outlet Syndrome / Q000150:complications; D018615:Ultrasonography, Doppler, Color; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*
D000925:Anticoagulants; D006493:Heparin
Les thromboses veineuses profondes des membres supérieurs. A propos de 49 cas.