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