Spectrum of upper-extremity deep venous thrombosis in a community teaching hospital.
OBJECTIVE
The goal of this study was to characterize the spectrum of upper-extremity deep venous thrombosis in a community teaching hospital.


METHODS
A retrospective analysis was used at a large urban teaching hospital.


METHODS
We reviewed the records of 90 patients with ultrasound-documented thrombosis of the internal jugular, subclavian, axillary, or brachial veins to determine clinical characteristics, risk factors, and outcome.


RESULTS
The most common underlying conditions associated with upper-extremity deep venous thrombosis were the presence of a central venous catheter in 65 patients (72%), infection in 25 (28%), extrathoracic malignancy in 20 (22%), thoracic malignancy in 19 (21%), renal failure in 19 (21%), and a prior lower-extremity deep venous thrombosis in 16 (18%). Pain was noted in 31 (34%) patients, and 76 patients (84%) had edema of the involved extremity. The left subclavian vein was involved in 44 patients (49%), and 35 patients (39%) had a central venous catheter in the left subclavian vein. When a central venous catheter was present, the deep venous thrombosis was usually ipsilateral (P <.001). Heparin and warfarin were administered to 65 (72%) and 53 (59%) of the patients, respectively. Eleven patients (12%) died. Of these patients, 8 (73%) had an underlying infection, whereas only 22% of survivors had an infection (P =.0012).


CONCLUSIONS
Upper-extremity deep venous thrombosis typically occurs in patients with a systemic illness in the presence of a central venous catheter. The left subclavian vein is frequently involved because this is a common site for placement of a central venous catheter. Pain is uncommon, but edema of the involved extremity is noted in the majority of patients. The mortality rate of patients in this study with an upper-extremity deep venous thrombosis was 12%; most patients who died had a central venous catheter and an underlying infection.
Marinella
M A
MA
Department of Internal Medicine, Wright State University School of Medicine, Dayton, Ohio, USA.
Kathula
S K
SK
Markert
R J
RJ
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001132:Arm / Q000098:blood supply; D001779:Blood Coagulation Factors; D002405:Catheterization, Central Venous / Q000009:adverse effects; D016009:Chi-Square Distribution; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D012307:Risk Factors; D020246:Venous Thrombosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D001779:Blood Coagulation Factors; D014859:Warfarin; D006493:Heparin