Spectrum of upper-extremity deep venous thrombosis in a community teaching hospital

Abstract

The goal of this study was to characterize the spectrum of upper-extremity deep venous thrombosis in a community teaching hospital. A retrospective analysis was used at a large urban teaching hospital. 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. 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). 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.