Paget-Schroetter Syndrome Research Articles

Doctor’s awareness of the Paget-Schroetter syndrome should be raised

Paget-Schroetter syndrome (PSS) is an axillo-subclavian venous thrombosis which occurs during effort, in presence of a thoracic outlet syndrome (TOS). Since the nineties, early in situ fibrinolysis is recommended after the beginning of the symptoms in order to limit the thrombotic sequelae. The objective of this study was to make an assessment of the preoperative rate of fibrinolysis in the treatment of PSS in our center.

Surgical decompression among Paget-Schroetter patients with subacute and chronic venous occlusion

ObjectiveManagement of Paget-Schroetter syndrome (PSS) with first rib resection (FRR) and venoplasty is successful in re-establishing subclavian vein (SCV) patency in most cases. However, in cases with subacute or chronic venous occlusion, SCV patency may not be achieved. Thus, the role for FRR remains controversial in cases of subacute or chronic SCV occlusion. Our goal is to determine whether FRR is beneficial in PSS patients with subacute or chronic SCV occlusion. MethodsA prospectively maintained thoracic outlet syndrome (TOS) database was searched for patients undergoing FRR who were identified as having SCV occlusion on preoperative venography between 2012 and 2021. Preoperative and postoperative venous patency were determined by venography. Standardized functional outcomes were assessed using the Quick Disability Arm, Shoulder, Hand (QuickDASH—QDS) and Somatic Pain Scale (SPS) before and after FRR. The Derkash outcome score was recorded after FRR. ResultsOver the study period, 966 TOS operations were performed; of these, 401 were for venous TOS, and 33 patients were identified with subacute or chronic preoperative SCV occlusion verified by venography. The median age was 29 years, with 73% men. Eighteen patients had attempted thrombolysis; eight were performed at our institution, and ten performed at a referring facility. The median time from the symptom onset of SCV occlusion to FRR was 78 days for all patients. For the group that achieved venous patency after FRR, the time from SCV occlusion to FRR was 71 days, and it was 106 days for the group that remained occluded after FRR. All underwent postoperative venography and percutaneous attempt at SCV recanalization. Recanalization was successful in 64% (21) and unsuccessful in 36% (12). All patients experienced improvement in SPS and QDS. For all patients, the average SPS improved from 1.69 preoperatively to 0.25 postoperatively and the average QDS improved from 27.63 preoperatively to 10.19 postoperatively (P > .05). For patients who were successfully recanalized, the final SPS was 0.18 and the final QDS was 11.22 (P > .05). In patients who failed to achieve recanalization, the final SPS was 0.40 and the final QDS was 9.06 (P > .05). All postoperative Derkash outcome scores were excellent and good, with none fair or poor. ConclusionsIn patients with subacute or chronic preoperative SCV occlusion, surgical decompression and postoperative angioplasty resulted in re-establishing SCV patency in 64% of patients. Symptomatic patients clinically improve after surgical decompression regardless of whether venous patency is successfully re-established. These results indicate that symptomatic patients with PSS should be considered for TOS decompression even if their SCV is occluded in the subacute or chronic presentation.

Clinical Presentation and Short- and Long-term Outcomes in Patients With Isolated Distal Deep Vein Thrombosis vs Proximal Deep Vein Thrombosis in the RIETE Registry

Insufficient data exist about the clinical presentation, short-term, and long-term outcomes of patients with isolated distal deep vein thrombosis (IDDVT), that is, thrombosis in infrapopliteal veins without proximal extension or pulmonary embolism (PE). To determine the clinical characteristics, short-term, and 1-year outcomes in patients with IDDVT and to compare the outcomes in unadjusted and multivariable adjusted analyses with patients who had proximal DVT. This was a multicenter, international cohort study in participating sites of the Registro Informatizado Enfermedad Tromboembólica (RIETE) registry conducted from March 1, 2001, through February 28, 2021. Patients included in this study had IDDVT. Patients with proximal DVT were identified for comparison. Patients were excluded if they had a history of asymptomatic DVT, upper-extremity DVT, coexisting PE, or COVID-19 infection. Primary outcomes were 90-day and 1-year mortality, 1-year major bleeding, and 1-year venous thromboembolism (VTE) deterioration, which was defined as subsequent development of proximal DVT or PE. A total of 33 897 patients were identified with isolated DVT (without concomitant PE); 5938 (17.5%) had IDDVT (mean [SD] age, 61 [17] years; 2975 male patients [50.1%]), and 27 959 (82.5%) had proximal DVT (mean [SD] age, 65 [18] years; 14 315 male patients [51.2%]). Compared with individuals with proximal DVT, those with IDDVT had a lower comorbidity burden but were more likely to have had recent surgery or to have received hormonal therapy. Patients with IDDVT had lower risk of 90-day mortality compared with those with proximal DVT (odds ratio [OR], 0.47; 95% CI, 0.40-0.55). Findings were similar in 1-year unadjusted analyses (hazard ratio [HR], 0.52; 95% CI, 0.46-0.59) and adjusted analyses (HR, 0.72; 95% CI, 0.64-0.82). Patients with IDDVT had a lower 1-year hazard of VTE deterioration (HR, 0.83; 95% CI, 0.69-0.99). In 1-year adjusted analyses of patients without an adverse event within the first 3 months, IDDVT was associated with lower risk of VTE deterioration (adjusted HR, 0.48; 95% CI, 0.24-0.97). By 1-year follow-up, symptoms or signs of postthrombotic syndrome were less common in patients with IDDVT (47.6% vs 60.5%). Results of this cohort study suggest that patients with IDDVT had a less ominous prognosis compared with patients with proximal DVT. Such differences were likely multifactorial, including the differences in demographics, risk factors, comorbidities, particularly for all-cause mortality, and a potential association of thrombus location with VTE deterioration and postthrombotic syndrome. Randomized clinical trials are needed to assess the optimal long-term management of IDDVT.

Outcome of Cancer-Associated Venous Thromboembolism Is More Favorable among Patients with Hematologic Malignancies than in Those with Solid Tumors.

The natural history of patients with hematologic cancer and venous thromboembolism (VTE) has not been consistently evaluated. We aimed to compare the rates of symptomatic recurrent VTE, major bleeding, or death during anticoagulant therapy in patients with VTE associated with hematologic versus solid cancers. Consecutive patients with active cancer recruited in RIETE were evaluated. Their baseline characteristics, treatments, and outcomes during the course of anticoagulation were compared. Univariate and multivariate competing-risk analyses were performed. As of December 2020, 16,694 patients with cancer and VTE were recruited. Of these, 1,062 (6.4%) had hematologic cancers. Hematologic patients were less likely to initially present with pulmonary embolism (46 vs. 55%) and more likely with upper extremity deep vein thrombosis (25 vs. 18%). They also were more likely to have severe thrombocytopenia at baseline (5.6 vs. 0.7%) or to receive chemotherapy (67 vs. 41%). During the course of anticoagulation (median, 150 vs. 127 days), 1,071 patients (6.4%) developed VTE recurrences, 806 (4.8%) suffered major bleeding, and 4,136 (24.8%) died. Patients with hematologic cancers had lower rates of recurrent VTE (rate ratio [RR]: 0.73; 95% confidence interval [CI]: 0.56-0.95), major bleeding (RR: 0.72; 95% CI: 0.53-0.98), or all-cause death (RR: 0.49; 95% CI: 0.41-0.57) than those with solid cancers. Patients with multiple myeloma showed the best outcomes. Patients with hematologic cancers, particularly multiple myeloma, and VTE had better outcomes than those with solid cancers. These findings are relevant for the interpretation of previous clinical trials and the design of future studies.

Subclavian Effort Thrombosis: Pathophysiology, Diagnosis, and Management.

Subclavian vein (SCV) effort thrombosis, also known as Paget-Schroetter syndrome or venous thoracic outlet syndrome, is an uncommon condition that affects individuals with an irregularly narrow thoracic outlet who engage in repetitive overhead motions of the affected arm. Venous injury arises from microtraumas that occur from the repetitive compression of the SCV between the first rib and the overlying clavicle. Additional sources of extrinsic compression can be due to the anterior scalene muscle, subclavius muscle, and costoclavicular ligament. SCV effort thrombosis is a distinct entity from other forms of deep venous thrombosis and requires unique diagnostic and treatment considerations. Early catheter-directed therapy in the form of pharmacomechanical or catheter-directed thrombolysis combined with prompt surgical thoracic outlet decompression offers patients the best chances for early and durable symptom relief.

P-11 Venous thromboembolism in colorectal cancer patients with BRAF mutation

Venous thromboembolism (VTE) is a frequent complication in colorectal cancer (CRC) patients. In these patients, some molecular biomarkers, such as KRAS mutation, have been associated with an increased risk of thrombosis. However, little is known about the characteristics of VTE associated with less prevalent molecular biomarkers. The aim of this analysis is to describe the characteristics of VTE of a cohort of ambulatory CRC patients harboring BRAF mutation. We performed a retrospective review of consecutive patients with BRAF-mutated CRC attended in the Medical Oncology Department of 10 hospitals from the network of the Cancer & Thrombosis Section of the Spanish Society of Medical Oncology (SEOM). Between January 2014 and June 2018, 165 patients were identified and included in the analysis. Mean age was 63.47 years (standard deviation [SD] 11.50 years) and 46.7% (n=77) were men. With a median follow-up of 15 months (interquartile range [IQR] 9-25), forty patients (24.2%) developed a VTE (32.4% pulmonary embolism, 24.3% lower-extremity deep-vein thrombosis [DVT], 2.7% upper-extremity DVT, 16.2% visceral thrombosis, 18.9% catheter related-thrombosis, 5.4% others). Most patients had metastatic disease (90.0%) and was receiving systemic therapy (73.7%). Median time from CRC diagnosis to VTE was 5.06 months (IQR 2.85-10.81). 50.0% of events were diagnosed incidentally and 75.0% in the ambulatory setting. Most patients (87.5%) received anticoagulant treatment (low-molecular-weight heparins [LMWH] 33 patients, direct oral anticoagulants [DOACs] 1 patient, others 1 patient), 35.9% for more than 6 months. 6 patients (15.4%) experienced VTE recurrence and 7 patients (19.4%) bleeding (mayor or fatal bleeding 4 patients). Median survival was 20.86 months for non-VTE patients and 11.30 months for VTE patients (hazard-ratio [HR] 2.13; CI 95% 1.38-3.28; p=0.001). VTE is associated with increased morbidity and mortality in patients with BRAF-mutated CRC.

Preoperative thrombolysis is associated with improved vein patency and functional outcomes after first rib resection in acute Paget-Schroetter syndrome

IntroductionMost patients with acute Paget-Schroetter syndrome (PSS) present in one of two manners: (1) thrombosis managed initially with thrombolysis and anticoagulation and then referred for surgery, and (2) initial treatment with anticoagulation only and later referral for surgery. Definitive benefits of thrombolysis in the acute period (the first 2 weeks after thrombosis) over anticoagulation alone have not been well reported. Our goal was to compare patients managed with early thrombolysis and anticoagulation followed by first rib resection (FRR) and later postoperative venography with venoplasty (PTA) with those managed with anticoagulation alone followed by FRR and PTA using vein patency assessed with venography and standardized outcome measures. MethodsWe reviewed a prospectively collected database from 2000 to 2019. Two groups were compared: those managed with early thrombolysis at our institution (Lysis) and those managed with anticoagulation alone (NoLysis). All patients underwent FRR. Venography was routinely performed before and after FRR. Standardized outcome measures included Quick Disability of Arm, Shoulder, and Hand (QuickDASH) scores and Somatic Pain Scale. ResultsA total of 50 Lysis and 50 NoLysis patients were identified. Pre-FRR venography showed that thrombolysis resulted in patency of 98% of veins, whereas 78% of NoLysis veins were patent. After FRR, postoperative venography revealed that 46 (92%) patients in the Lysis group and 37 (74%) patients in the NoLysis group achieved vein patency. Thrombolysis was significantly associated with final vein patency (odds ratio: 17 [4-199]; P < .001). Lysis patients had a trend toward lower QuickDASH scores from pre-FRR to post-FRR compared with NoLysis patients with a mean difference of −16.4 (±19.7) vs −5.2 (±15.6) points (P = .13). The difference in reduction of Somatic Pain Scale scores was not statistically significant. ConclusionsThrombolysis as initial management of PSS, combined with anticoagulation, followed by FFR and VenoPTA resulted in improved final vein patency and may lead to an improved functional outcome measured with QuickDASH scores. Therefore, clinical protocols using thrombolysis as initial management should be considered when planning the optimal treatment strategy for patients with acute PSS.

A SERPINC1 Mutation in a Patient with Cerebral Venous Thrombosis and Upper-Extremity Deep Vein Thrombosis

A SERPINC1 Mutation in a Patient with Cerebral Venous Thrombosis and Upper-Extremity Deep Vein Thrombosis

Deep vein thrombosis and pulmonary embolism after heart transplantation.

Venous thromboembolism (VTE), such as deep vein thrombosis (DVT) and pulmonary embolism (PE), is an important and serious postoperative complication after heart transplantation. We sought to characterize in-hospital VTE after heart transplantation and its association with clinical outcomes. Adult (≧18 years) patients undergoing heart transplantation from 2015 to 2019 at our center were retrospectively reviewed. Post-transplant VTE was defined as newly diagnosed venous system thrombus by imaging studies. There were 254 patients. The cohort's median age was 55 years. A total of 61 patients were diagnosed with VTE, including one with right atrial thrombus, 54 with upper extremity DVT in which one patient subsequently developed PE, four with lower extremity DVT, and two with upper and lower extremity DVT. The cumulative incidence of VTE was 42% at 60-days of post heart transplant. Patients with VTE had longer hospital stay (P<.001), higher in-hospital mortality (P=.010), and worse 5-year survival (P=.009). On the multivariable Cox analysis, history of DVT/PE and intubation for more than 3 days were associated with an increased risk of in hospital VTE. The incidence of VTE in heart transplant recipients is high. Post-transplant surveillance, and appropriate preventive measures and treatment strategies after diagnosis are warranted.

Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline 2022.

No matter the practice setting, physical therapists work with patients who are at risk for or who have a history of venous thromboembolism (VTE). In 2016, the first clinical practice guideline (CPG) addressing the physical therapist management of VTE was published with support by the American Physical Therapy Association's Academy of Cardiovascular and Pulmonary Physical Therapy and Academy of Acute Care, with a primary focus on lower extremity deep vein thrombosis (DVT). This CPG is an update of the 2016 CPG and contains the most current evidence available for the management of patients with lower extremity DVT and new key action statements (KAS), including guidance on upper extremity DVT, pulmonary embolism, and special populations. This document will guide physical therapist practice in the prevention of and screening for VTE and in the management of patients who are at risk for or who have been diagnosed with VTE. Through a systematic review of published studies and a structured appraisal process, KAS were written to guide the physical therapist. The evidence supporting each action was rated, and the strength of statement was determined. Clinical practice algorithms based on the KAS were developed that can assist with clinical decision-making. Physical therapists, along with other members of the health care team, should implement these KAS to decrease the incidence of VTE, improve the diagnosis and acute management of VTE, and reduce the long-term complications of VTE.

Is there something new in the diagnosis and treatment of TOS and Paget-Schroetter syndrome ?

Thoracic outlet syndrome is a syndrome of pathologic neurologic and vascular symptoms involving the upper limb. Its most serious complication, Paget-Schroetter Syndrome, is a major clinical problem, posing a significant diagnostic and therapeutic challenge to specialists not only in angiology and vascular surgery but also in neurology and physiotherapy. There is a need for in-depth examination and differentiation of patients with suspected compression syndrome. We present a review paper covering the diagnosis and treatment of thoracic outlet syndrome.

PO-23: Upper extremity deep vein thrombosis in cancer patients: our experience

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Brachial Plexopathy Due to Upper-Extremity Deep Vein Thrombosis: A Case Report

Upper-extremity deep vein thrombosis (DVT) accounts for 1% to 4% of DVT cases. Brachial plexus injury can result from venous distention due to thrombosis in the upper extremity, leading to neurologic deficits. We report a patient diagnosed with brachial plexopathy caused by venous thrombosis in the upper extremity. A 66-year-old female patient with a medical history of Parkinson disease and dementia presented to the emergency department with drowsy mental status. She was diagnosed with pre-renal acute kidney injury with multi-organ dysfunction. On the second hospital day, right upper extremity edema and muscle weakness were observed. On the sixth hospital day, the patient’s overall medical condition improved after conservative treatment, but severe edema was noticed, and muscle weakness did not show significant improvement in the right upper extremity. Computed tomography showed multifocal pulmonary thromboembolism and DVT in the pulmonary arteries, superior vena cava, and popliteal veins. After anticoagulant administration, the swelling subsided, but the weakness in the entire right upper extremity did not improve. Electromyography demonstrated right brachial pan-plexopathy involving the upper, middle, and lower trunks. A follow-up examination showed no significant improvement of muscle strength and function in the right upper extremity at 3 months after the first hospital day.

Venous and Arterial Thoracic Outlet Syndrome Requiring Surgical Intervention: Two Case Reports

Background: Thoracic outlet syndrome represents a spectrum of diseases depending on the structures involved. Most cases of thoracic outlet syndrome (TOS) are neurogenic while arterial and venous TOS constitute only 5% of the cases. Paget-Schroetter syndrome represents an acute complication of venous thoracic outlet syndrome (vTOS) commonly occurring in physically active individuals participating in strenuous upper body exercises. Arterial thoracic outlet syndrome (aTOS) is usually associated with bony abnormalities. We discuss one patient of each type who presented with acute thrombosis to illustrate the different associated factors and treatment options. Case Report(s): An 18-year-old Hispanic male presented with six days of left upper extremity (LUE) edema and pain that began following an upper body exercise. He was treated by pharmacomechanical thrombectomy followed by ultrasound assisted catheter-directed thrombolysis. Subsequently the patient underwent trans axillary surgical decompression of the thoracic outlet. A 59-year-old South Asian woman presented with worsening LUE pain, weakness and paresthesia of 10 days duration. She underwent pharmacomechanical thrombectomy with angioplasty followed by supraclavicular thoracic outlet decompression. Conclusions: Treatment of TOS presenting with thrombosis should consist of prompt thrombectomy followed by surgical decompression.

Obesity increases the risk for upper extremity deep vein thrombosis and pulmonary embolism in patients with upper extremity central venous catheters.

The morbidity and mortality of deep vein thrombosis (DVT) remain a significant burden for the healthcare system. The aim of this analysis was to examine the association of upper extremity central venous catheter (UECVC) and venous thromboembolism (UEVTE) with increasing body mass index (BMI) in a large database study and to further examine disposition. Inpatient data from the National Inpatient Sample from 2017 to 2019 were used to investigate the effect of obesity on patients diagnosed with DVT of the upper extremity or pulmonary embolism (PE) who had upper extremity venous central line placement. There was a total of 1690 cases of UEVTE and 3202 cases of PE within the sample. There was an increasing odds of UEVTE in the patients with UECVCs with increasing BMI. Patients with a BMI of 30-39, 40-49 and > 50 kg/m2 were significantly different than those with BMI of <19 and 20-29 kg/m2 in the UECVC group for UEVTE. This study demonstrated increased odds of UEVTE for patients with increased BMI. Practitioners should assume a greater risk for UEVTE and PE in patients with increased BMI when considering CVCs.

Paget-Schroetter Syndrome: A Case Report of effort induced upper extremity venous thrombosis

Effort induced thrombosis of the axillary-subclavian vein, also referred as Paget-Schroetter syndrome, is a relatively uncommon type of deep vein thrombosis of the upper extremity. Although rare, understanding its clinical presentation and etiology is essential for timely diagnosis and formatting correct treatment protocols. Most upper extremity deep vein thrombosis are secondary to either underlying pathology including cancer, chronic indwelling catheters, and hypercoaguable states making their clinical diagnosis relatively straight forward. On the contrary, effort induced deep vein thrombosis most commonly occur in young otherwise healthy people. Early detection and treatment of this type of thrombosis are essential in preventing late-term complications including post-thrombotic syndrome, and pulmonary embolus. There is no current consensus in treatment of effort induced upper extremity thrombosis with literature supporting conservative versus surgical treatment depending on patient presentation and physician preference.

Patient-Friendly Summary of the ACR Appropriateness Criteria: Suspected Upper-Extremity Deep Vein Thrombosis

Deep vein thrombosis (DVT) occurs when there is a clot in a vein that is deep within your body. If this happens in your upper extremity (arm, wrist, or hand), it is called upper-extremity DVT. Causes of upper-extremity DVT include trauma, infection, inflammation, heart failure, pregnancy, and cancer. Symptoms may include upper-extremity swelling, pain or tingling, heaviness, or a feeling of “pins and needles.” Upper-extremity DVTs are sometimes associated with having a device in the body such as a catheter, pacemaker, or defibrillator.

Incidence of Deep Venous Thrombosis (DVT) in Head and Neck Cancer Patients Receiving IV Fluids (IVF) via Peripheral IV (PIV) Compared to Central Venous Catheter

<h3>Purpose/Objective(s)</h3> Venous thromboembolism (VTE) is a common complication among cancer patients with a reported incidence close to 15% per year.^(1-3) One study found a VTE risk of 18.3% in the head and neck (H&N) cancer population using the Caprini risk assessment model.⁴ Up to 66% of VTE occurring in the upper extremity are due to intravenous catheters.⁵ This implies that recurring IV access for hydration would induce a clinically significant level of endothelial inflammation resulting in a higher risk of VTE. Therefore, patients with H&N cancer undergoing chemoradiotherapy who require repeated IV insertion for IV hydration appear to be at an increased risk for DVTs. We wanted to estimate the risk of DVT among H&N cancer patients undergoing regular IV hydration via peripheral IV as opposed to central venous catheter (CVC) to see if CVC use reduces the risk of DVT. <h3>Materials/Methods</h3> A retrospective database was created for patients at our institution from CY2019 to CY2020 who had a diagnosis of H&N cancer. We recorded the type of cancer, presence and location of DVT, if they were receiving IVF and if so, via CVC or PIV, and treatment received (chemo +/- XRT). We analyzed the number of patients who developed DVT and evaluated if there was a difference in incidence of DVT between those who received IVF through PIV or CVC. <h3>Results</h3> Out of 72 patients with H&N cancer, 7 were found to have DVT (9.7%). 57% of patients developed upper extremity DVT and 43% lower extremity. Two with DVT also had pulmonary embolus. 57% of patients were receiving IVF 2-3 times/week via PIV, 14% were receiving IVF through CVC, and the remaining 29% did not receive IVF. Out of these 7 patients who developed DVT, 6 (85.7%) were receiving both chemotherapy and radiation at the time of DVT, and the remaining patient was not receiving cancer treatment. <h3>Conclusion</h3> The data show a significant incidence of VTE among H&N cancer population. The preliminary data also shows an increased incidence of DVT among those receiving IVF via PIV compared to CVC, which supports a change of hydration protocol from PIV to CVC. Further prospective data will be obtained to add to the analysis.

A Case of Right Upper-extremity Deep Vein Thrombosis and Acute Pulmonary Embolism Associated to Kanto Acting

A Case of Right Upper-extremity Deep Vein Thrombosis and Acute Pulmonary Embolism Associated to Kanto Acting

Incidence of upper extremity deep vein thrombosis in the retrosternal reconstruction after esophagectomy

BackgroundUpper extremity deep vein thrombosis (UEDVT) is relatively rare but cannot be negligible because it can cause fatal complications. Although it is reported that the occurrence rate of UEDVT has increased due to central venous catheter (CVC), cancer, and surgical invasion, there is still limited information for esophagectomy. The aim of this study was to evaluate the clinical factors, including CVC placement and thromboprophylaxis approach, as well as retrosternal space’s width as a predictive factor for UEDVT in patients receiving esophagectomy.MethodsThis study included 66 patients who underwent esophagectomy with retrosternal reconstruction using a gastric tube. All patients routinely underwent contrast-enhanced computed tomography (CT) on the 4th postoperative day. Low-molecular-weight-heparin (LMWH) was routinely administered by the 2nd postoperative day. To evaluate retrosternal space’s width, (a) The distance from sternum to brachiocephalic artery and (b) the distance from sternum to vertebra were measured by preoperative CT, and the ratio of (a) to (b) was defined as the width of retrosternal space.ResultsAmong all patients, 11 (16.7%) suffered from UEDVT, and none was preoperatively received CVC placement, while 7 were inserted in non-UEDVT cases. Retrosternal space’s width in patients with UEDVT was significantly smaller than that in patients without UEDVT (0.17 vs. 0.26; P < 0.0001). A cutoff value of the width was 0.21, which has high sensitivity (87%) and specificity (82%) for UEDVT prediction, respectively.ConclusionThe existence of CVC may not affect the development of UEDVT, but preoperative evaluation of retrosternal ratio may predict the occurrence of UEDVT.