title: Upper limb deep vein thrombosis: a literature review to streamline the protocol for management.
abstract: OBJECTIVE
  The objective of this article is to provide up-to-date information about aetiology, pathogenesis, diagnostic modalities and treatment of upper limb deep vein thrombosis (ULDVT).
  
  
  METHODS
  Generic terms including ULDVT, axillary-subclavian DVT, and complications of central venous catheters were searched on electronic database. We analysed original studies, review articles and evaluation studies published over the last 25 years.
  
  
  RESULTS
  Forty-seven studies on ULDVT encompassing 2,557 patients were evaluated. The incidence of ULDVT was quoted 1-4% of the total DVT. Primary ULDVT (20% of the total) was due to activity-related venous trauma. Secondary ULDVT (80% of the total) was due to central venous catheters and malignancy. Duplex ultrasound (sensitivity 78-100% and specificity 82-100%), contrast venography (gold standard) and magnetic resonance venography were the diagnostic tools used. Pulmonary embolism (2-35%) and post-thrombotic syndrome (7-46%) were the main sequelae. Anticoagulation was the universal intervention, giving 79% symptom relief (13.2% rethrombosis rate). Thrombolysis and/or percutaneous thrombectomy were used in 38% of cases for the management of ULDVT, giving 83% symptom relief (90% recanalization rate and 9% rethrombosis rate). Surgical decompression, venous angioplasty and superior vena cava filters were the main adjunctive interventions.
  
  
  CONCLUSIONS
  ULDVT, although rare, is associated with considerable morbidity and mortality (29-40%) due to potential risks of pulmonary embolism, post-thrombotic syndrome and loss of vascular access. Simple anticoagulation is suitable for the majority of patients. Thrombolysis/thrombectomy is often successful but less frequently used. Surgical decompression, venous angioplasty and superior vena cava filters have some role in recurrent cases. An optimal management protocol can be established using a multimodality approach.
authors.affiliation: Department of Vascular Surgery, Royal Free Hospital, Hampstead, London, UK. surgeon1wrh@hotmail.com
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Sajid
authors.forename: Naeem
authors.initials: N
authors.lastname: Ahmed
authors.forename: Mittal
authors.initials: M
authors.lastname: Desai
authors.forename: Daryll
authors.initials: D
authors.lastname: Baker
authors.forename: George
authors.initials: G
authors.lastname: Hamilton
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D017130:Angioplasty / Q000379:methods; D000925:Anticoagulants / Q000627:therapeutic use; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011379:Prognosis; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D017131:Thrombectomy / Q000379:methods; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D034941:Upper Extremity; D020246:Venous Thrombosis / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*
chemical_list: D000925:Anticoagulants