A case of upper extremity deep vein thrombosis with long-term patency using pharmaco-mechanical catheter-directed thrombolysis in the acute phase

Abstract

Although upper-extremity deep vein thrombosis (UEDVT) is considered rare, its prevalence appears to be increasing, and this may be related to expanding indications for catheter-based interventions. In contrast, few cases have been reported related to strenuous exercise, especially in healthy young adults with thoracic outlet syndrome (Paget-Schroetter syndrome). In contrast to lower-extremity DVT, optimal treatment strategies for UEDVT have not been robustly studied.In this report, we describe a 56-year-old man with primary UEDVT presenting with left arm swelling, paresthesia, and visible collateral veins around the shoulder. Venography revealed thrombotic occlusion of the left subclavian vein. Emergent pharmaco-mechanical catheter-directed thrombolysis (PCDT) was performed, and his left subclavian vein was recanalized. A novel oral anticoagulant was initiated to prevent reclosure. The patient’s symptoms subsided without major bleeding complications and at six months, he has no disability for daily activities. Follow-up ultrasonography revealed almost complete patency of the left subclavian vein, after which anticoagulation therapy was terminated.We discuss the role of PCDT in the management of primary UEDVT from the perspective of efficacy and contribution to quality of life.<Learning objective: UEDVT is relatively rare and has not been examined as extensively as lower-extremity DVT. Nonetheless, patients may have a variety of unpleasant symptoms that substantially decrease quality of life. Pharmaco-mechanical catheter-directed thrombolysis may be effective to reduce clot burden and mitigate the risk of post-thrombotic syndrome. Although there is no current consensus about exact indications for UEDVT patients, the procedure may be more useful than the standard anticoagulant therapy.>