title: Upper extremity vein thrombosis: etiologic categories, precipitating causes, and management.
abstract: Although an increasing incidence of upper extremity venous thrombosis (U/E-DVT) has been reported, a relative paucity of information regarding the etiologic categories, precipitating causes, and proper management for this disorder is available. To settle on a strategy for the management of U/E-DVT, retrospective analyses were performed using records from the authors' hospital. In 12 patients (seven men, five women), 61 (mean) years of age, diagnosed as having symptomatic venography-proved U/E-DVT and followed up for 41 (mean) months, etiologic factors, precipitating causes, treatments, and outcomes were retrospectively analyzed. As etiologic factors, five of the patients had neoplastic disease, one had hemodialysis, and two had transvenous pacemaker implantations. Among various precipitating causes of U/E-DVT, hypoproteinemia was most frequently noted (67%). Various types of therapeutic management were selected: from thrombolysis with urokinase in six, balloon angioplasty in two, thrombectomy in two, and venous bypass surgery in one patient. Pulmonary embolism did not occur in any of the patients and only three of them complained of mild intermittent arm swelling during the follow-up period. Four patients died of neoplastic disease or heart failure (three within the first 6 months). This study, though limited, suggests that the rate of mortality depends on multiple underlying medical problems in U/E-DVT patients. Low incidences of late postthrombotic sequelae and pulmonary embolism were noted in this series. Symptomatic U/E-DVT patients could be managed conservatively with a revised supplementary therapy for their precipitating causes of U/E-DVT.
authors.affiliation: Department of Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba City, Ibaraki, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Sakakibara
authors.forename: O
authors.initials: O
authors.lastname: Shigeta
authors.forename: S
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Y
authors.initials: Y
authors.lastname: Hiramatsu
authors.forename: T
authors.initials: T
authors.lastname: Jikuya
authors.forename: M
authors.initials: M
authors.lastname: Onizuka
authors.forename: T
authors.initials: T
authors.lastname: Mitsui
mesh_terms: D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon; D001132:Arm / Q000098:blood supply*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D016470:Bacteremia / Q000150:complications; D001943:Breast Neoplasms / Q000150:complications; D002423:Cause of Death; D004938:Esophageal Neoplasms / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007019:Hypoproteinemia / Q000150:complications; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects; D010960:Plasminogen Activators / Q000627:therapeutic use; D006435:Renal Dialysis / Q000009:adverse effects; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000150:complications; D013274:Stomach Neoplasms / Q000150:complications; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D020246:Venous Thrombosis / Q000209:etiology* / Q000628:therapy
chemical_list: D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator