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Risk Factors, Diagnosis, and Complications

Paolo Prandoni, MD, PhD; Paola Polistena, MD; Enrico Bernardi, MD; Alberto Cogo, MD, PhD; Dario Casara, MD; Fabio Verlato, MD; Federico Angelini, MD; Paolo Simioni, MD; Gian Paolo Signorini, MD; Lino Benedetti, MD; Antonio Girolami, MD

Arch Intern Med. 1997;157(1):57-62.

Abstract
Background
Little is known about the clinical, diagnostic, and prognostic aspects of upper-extremity deep vein thrombosis (UEDVT).

Objectives
To identify the clinical and laboratory parameters associated with this disease, to assess the diagnostic accuracy of ultrasonographic methods for its detection, and to establish the frequency of both early and late complications.

Patients and Methods
After a careful history was taken, 58 consecutive patients with signs and symptoms that were clinically suggestive of UEDVT underwent the determination of antithrombin III and protein C and S levels and resistance to activated protein C and lupuslike anticoagulants. Compression ultrasonography, color flow Doppler imaging, and Doppler ultrasonography were performed prior to venography. Patients with confirmed UEDVT underwent objective tests to detect a pulmonary embolism and were followed up prospectively to record recurrent thromboembolic events and postthrombotic sequelae.

Results
Findings from venography confirmed UEDVT in 27 patients (47%). Central venous catheters, thrombophilic states, and a previous leg vein thrombosis were statistically significantly associated with UEDVT. Sensitivity and specificity of compression ultrasonography (96% and 93.5%, respectively) and color flow Doppler imaging (100% and 93%, respectively) were comparable and better than those of Doppler ultrasonography (81% and 77%, respectively). Objective findings suggestive of a pulmonary embolism were recorded in 36% of the patients with UEDVT. After a mean follow-up of 2 years, 2 patients with UEDVT experienced recurrent thromboembolic events, and 4 had postthrombotic sequelae.

Conclusions
Symptomatic UEDVT is associated with central venous catheters, thrombophilic states, and a previous leg vein thrombosis. Both compression ultrasonography and color flow Doppler imaging are accurate methods for its detection. A pulmonary embolism is a common complication of the disease. Finally, this disorder may recur and may be followed by postthrombotic sequelae.

Arch Intern Med. 1997;157:57-62

Author Affiliations
From the Institute of Medical Semeiotics (Drs Prandoni, Polistena, Bernardi, Cogo, Simioni, and Girolami), Services of Nuclear Medicine (Dr Casara) and Angiology (Drs Verlato and Signorini), and Second Service of Radiology (Drs Angelini and Benedetti), University Hospital of Padua, Padua, Italy.

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