Review article
The post-thrombotic syndrome after upper extremity deep venous thrombosis in adults: A systematic review

https://doi.org/10.1016/j.thromres.2005.05.029Get rights and content

Abstract

Background

Post-thrombotic syndrome is a chronic, potentially debilitating complication of deep vein thrombosis (DVT) of the lower extremity. Comparatively little is known about post-thrombotic syndrome after upper extremity DVT (UEDVT).

Objective

To perform a systematic review of clinical studies that have examined the incidence, clinical features, risk factors and management of post-thrombotic syndrome after UEDVT.

Methods

Using combinations of keywords venous thrombosis, postphlebitic syndrome, thrombophlebitis, arm swelling, post-thrombotic syndrome, UEDVT, Paget–Schroetter syndrome, thoracic outlet syndrome, axillary vein, subclavian vein, and central venous catheter, the MEDLINE database was searched for English language articles published between January 1967 and December 2004. Retrieval and review of articles were restricted to clinical studies in humans that described long-term outcomes after objectively confirmed UEDVT.

Results

Seven studies were reviewed. The frequency of PTS after UEDVT ranges from 7–46% (weighted mean 15%). Residual thrombosis and axillosubclavian vein thrombosis appear to be associated with an increased risk of PTS, whereas catheter-associated UEDVT may be associated with a decreased risk. There is currently no validated, standardized scale to assess upper extremity PTS, and little consensus regarding the optimal management of this condition. Quality of life is impaired in patients with upper extremity PTS, especially after DVT of the dominant arm.

Conclusions

PTS is a frequent complication of UEDVT, yet little is known regarding risk factors and optimal management. A standardized means of diagnosis would help to establish better management protocols. The impact of upper extremity PTS on quality of life should be further quantified.

Introduction

Although most episodes of deep venous thrombosis (DVT) occur in the lower extremities, it has been estimated that 1–4% of cases involve the upper extremities [1], [2]. Upper extremity deep vein thrombosis (UEDVT) is an increasingly common clinical problem due to the growing use of cardiac pacemaker implantation and central venous catheters for drug delivery in both in-patient and out-patient settings [3], [4], [5], [6], [7]. UEDVT can be classified into two etiologic groups: primary (includes idiopathic, effort-related or Paget–Schroetter syndrome and thoracic outlet syndrome) and secondary (provoked by central venous catheters, pacemakers or cancer) [8]. Secondary causes underlie most cases of UEDVT; in particular, it has been reported that central venous catheters account for about 75% of all cases [9]. Conversely, primary UEDVT is rare, occurring in only 2 / 100,000 persons per year [10].

The post-thrombotic syndrome (PTS) is a chronic, potentially debilitating complication of DVT of the lower extremity that is characterized by limb pain, heaviness, swelling, cramps, edema, varicosities and in severe cases, ulcers [11]. PTS has been estimated to develop in 20–50% of patients after lower extremity DVT [11], has adverse effects on quality of life [12] and incurs high costs [13]. However, it is less well known whether PTS also occurs after UEDVT. It can be appreciated that the development of PTS in an upper extremity could be burdensome and disabling, particularly if it occurred in the dominant arm. The objectives of this paper were to systematically review the published literature on the incidence, clinical features, predictors and management of PTS after UEDVT.

Section snippets

Methods

A computerized search of the MEDLINE database from January 1967 to December 2004 was performed to identify English language articles on the PTS after upper extremity DVT. Various combinations of the search terms postphlebitic syndrome, post-thrombotic syndrome, thrombophlebitis or arm swelling, were combined with one or more of the search terms upper extremity deep venous thrombosis, venous thrombosis, axillary vein, subclavian vein, arm, effort thrombosis, Paget–Schroetter syndrome, upper

Results

Our literature search revealed 7 articles that met our criteria for inclusion in this review. There were 3 prospective cohort studies and 4 retrospective cohort studies. A total of 432 patients were described (Table 1).

Acknowledgements

Dr. Kahn is the recipient of a Clinical Research Scientist award of the Fonds de la Recherche en Santé du Québec.

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