Upper Extremity Deep Vein Thrombosis

Upper extremity deep vein thrombosis (UEDVT) is a relatively uncommon condition, occurring less frequently than deep vein thrombosis (DVT) in the lower extremities. It represents only a small portion, accounting for approximately 1–4%, of all DVT cases. Researchers from Kaplan Medical Center in Israel have identified several risk factors associated with primary UEDVT, including young age, intense exercise involving the upper extremities, and repetitive overhead hyperabduction in individuals with thoracic outlet anatomical abnormalities. The typical presentation of an acute UEDVT involves arm pain and swelling. Additional symptoms and signs may include discomfort in the shoulder, neck, or axilla, superior vena cava syndrome, cyanosis of the hand and fingers, and a low-grade fever. The D-dimer test is employed to exclude the possibility of thrombosis. Various imaging techniques play a crucial role in confirming the diagnosis. In terms of treatment, aside from providing supportive care, all patients with UEDVT, unless contraindicated, should receive anticoagulation therapy with low-molecular-weight heparin or fondaparinux, followed by vitamin K antagonists for a period of 3–6 months. In cases where anticoagulation treatment is contraindicated, the insertion of a percutaneous umbrella-filter into the superior vena cava may be considered. Moreover, surgical thoracic outlet decompression should be contemplated for all patients with primary UEDVT. Recently, percutaneous mechanical thrombectomy, which aims to remove the thrombus, has emerged as a highly effective treatment option.