Upper Limb Management
Treatment options for upper extremity DVTs (typically in the axillary, subclavian, or brachial vein) vary from conservative management (heat, rest, and arm elevation), to anticoagulation, thrombolysis, thrombectomy, and surgical decompression.
Studies have not yet clearly indicated the superiority of thrombolysis or thrombectomy followed by anticoagulation over anticoagulation alone for the treatment of most upper extremity DVTs, although several studies have suggested potential benefit.
SVC filters have a role in treating patients for whom anticoagulation therapy failed or who have contraindications to anticoagulation. Filters have also been shown to be effective in preventing subsequent pulmonary embolism (PE).
Angioplasty or stenting may be appropriate when anticoagulation or thrombolysis results in incomplete recanalization of the vein and persistent symptoms are present. If the upper extremity DVT is a result of thoracic outlet syndrome, venous angioplasty or stents rarely relieve symptoms adequately.
Venous bypass may be used when venous compression or thrombosis have resulted in vessel obliteration.
Surgical decompression of the thoracic outlet has been efficacious in the management of spontaneous or exertion-related upper extremity DVTs.
References:
Marshall, P. and Cain, H. Upper Extremity Deep Vein Thrombosis. 2010. Clin. Chest Med 31: 783-797.
Treatment options for upper extremity DVTs (typically in the axillary, subclavian, or brachial vein) vary from conservative management (heat, rest, and arm elevation), to anticoagulation, thrombolysis, thrombectomy, and surgical decompression.
Studies have not yet clearly indicated the superiority of thrombolysis or thrombectomy followed by anticoagulation over anticoagulation alone for the treatment of most upper extremity DVTs, although several studies have suggested potential benefit.
SVC filters have a role in treating patients for whom anticoagulation therapy failed or who have contraindications to anticoagulation. Filters have also been shown to be effective in preventing subsequent pulmonary embolism (PE).
Angioplasty or stenting may be appropriate when anticoagulation or thrombolysis results in incomplete recanalization of the vein and persistent symptoms are present. If the upper extremity DVT is a result of thoracic outlet syndrome, venous angioplasty or stents rarely relieve symptoms adequately.
Venous bypass may be used when venous compression or thrombosis have resulted in vessel obliteration.
Surgical decompression of the thoracic outlet has been efficacious in the management of spontaneous or exertion-related upper extremity DVTs.
References:
Marshall, P. and Cain, H. Upper Extremity Deep Vein Thrombosis. 2010. Clin. Chest Med 31: 783-797.