No abstract available.
Upper Extremity Deep Vein Thrombosis

Spontaneous thrombosis of the subclavian vein, termed "effort thrombosis" or the Paget-Schroetter Syndrome, has long been considered a primary thrombotic process, but recent experience suggests that it may commonly result from repeated mechanical compression. This syndrome is unusual and is frequently considered inconsequential compared with thrombosis of the iliac or femoral vein. However, pulmonary embolism has been documented in up to 15% of patients with subclavian thrombosis. Many patients with this disorder are offlicted by disabling symptoms of upper extremity venous congestion. It is now recognized that the morbidity of this condition is significant and its traditional treatment needs serious reconsideration. Presumed to be a primary thrombotic disorder, its treatment has traditionally consisted of arm elevation and anticoagulation. Increased awareness of the pathophysiology of this symdrome can allow timely, improved diagnostic screening and use of specific surgical intervention to relieve the venous consequences. During the 44 months we have treated 5 patients with the thrombosis of subclavian vein. There were two men and three women with an average of 50 years(range from 40~61 years). And all patients presented with pain, swelling, and cyanosis of the upper extremity. Venous congestion worsened especially with abduction of the arm. Three of five patients were originally treated with arm elevation and anticoagulation; two also underwent surgical intervention.
Arm ; Cyanosis ; Female ; Femoral Vein ; Humans ; Hyperemia ; Male ; Mass Screening ; Pulmonary Embolism ; Subclavian Vein ; Thrombosis ; Upper Extremity ; Upper Extremity Deep Vein Thrombosis

Paget-Schroetter syndrome is synonymous with spontaneous or effort-induced thrombosis of the axillosubclavian vein that is characterized by swelling and pain on upper extremity. Though axillosubclavian thrombosis represents only 1 - 2%, its frequency of diagnosis has increased over the past years due to improvement of ultrasonography. Although the cause of catheter and drug-related cases is clear, several studies have invested the etiology of Paget- Schroetter syndrome, a condition more commonly seen in the young and otherwise healthy individual. Factors often cited include compression of the vein by the anatomic structure, stress, or excessive effort to the extremity, and repetitive shoulder-arm motion. In the view of treatment, thrombolysis by direct infusion of urokinase has proven to be superior to surgical thrombectomy and is now treatment of choice. We successfully treated a 30-year-old man who suffered from swelling and pain on the right upper extremity by using direct urokinase infusion on thrombosis of subclavian vein. This is very rare disease in plastic and reconstructive surgery, thus diagnosis will seldom be made on clinical evaluation. It should be included in the differential diagnosis of upper extremity swelling compared with lymphedema.
Adult ; Catheters ; Diagnosis ; Diagnosis, Differential ; Extremities ; Humans ; Lymphedema ; Plastics ; Rare Diseases ; Subclavian Vein ; Thrombectomy ; Thrombosis ; Ultrasonography ; Upper Extremity ; Upper Extremity Deep Vein Thrombosis ; Urokinase-Type Plasminogen Activator ; Veins

Deep vein thrombosis (DVT) is a predisposing condition of pulmonary embolism which can be fatal. Usually, DVT is found in the lower extremities. However, DVT can be occurred in the upper extremities. The usual predisposing conditions of the upper extremity DVT include insertion of central venous catheters and pacemaker wires. Here, we report a case of upper extremity DVT after in vitro fertilization and embryo transfer. The patient was successfully controlled with subcutaneous administration of low molecular weight heparin.
Central Venous Catheters ; Embryo Transfer ; Fertilization in Vitro ; Heparin, Low-Molecular-Weight ; Humans ; Lower Extremity ; Pulmonary Embolism ; Upper Extremity ; Upper Extremity Deep Vein Thrombosis ; Venous Thrombosis

Deep vein thrombosis is a predisposing condition for pulmonary embolism, which can be fatal. Usually, deep vein thrombosis is found in the lower extremities, but it can also occur in the upper extremities. The prevalence of upper extremity deep vein thrombosis appears to be increasing, particularly due to the increased use of indwelling central venous catheters. Pulmonary embolism is present in up to one-third of patients with upper extremity deep vein thrombosis. Upper extremity deep vein thrombosis is an increasingly important clinical entity, with the potential for considerable morbidity. Here, we report a case of upper extremity deep vein thrombosis and pulmonary embolism in a severely obese man who was successfully treated with anticoagulants.
Anticoagulants ; Central Venous Catheters ; Humans ; Lower Extremity ; Prevalence ; Pulmonary Embolism* ; Thoracic Outlet Syndrome ; Upper Extremity Deep Vein Thrombosis* ; Upper Extremity* ; Venous Thrombosis

PURPOSE: The incidence and recognition of upper extremity deep venous thrombosis (UEDVT) has increased because of the use of central venous catheters and other central vein access procedures. UEDVT is associated significant mortality and a significant incidence of pulmonary embolism. The aim of this study is to report on our clinical experience with endovascular treatment in UEDVT patients. METHODS: We retrospectively reviewed 6 patients who had UEDVT at the Chonbuk National University Hospital between March 2001 and January 2008. RESULTS: The most common presenting symptom of UEDVT was upper extremity swelling and pain. The patients received catheter-directed thrombolytic therapy, aspiration thrombectomy, percutaneous balloon angioplasty and/or stent insertion. All the patients achieved complete restoration of venous patency and their symptoms improved. CONCLUSION: Endovascular treatment is an effective method for the treatment of UEDVT. More studies are required to determine the long-term efficacy of endovascular treatment in UEDVT patients.
Angioplasty, Balloon ; Central Venous Catheters ; Humans ; Incidence ; Pulmonary Embolism ; Retrospective Studies ; Stents ; Stress, Psychological ; Thrombectomy ; Thrombolytic Therapy ; Upper Extremity ; Upper Extremity Deep Vein Thrombosis ; Veins ; Venous Thrombosis

Venous thrombosis in atypical locations means thrombosis of upper extremity deep vein, cerebral venous sinus, splanchnic vein including portal, hepatic, mesenteric and splenic vein, renal vein, ovarian vein and retinal vein. This thrombosis rarely occurred and could be affected by the involved organ when compared to the incidence and cause of deep vein thrombosis in lower extremity with or without pulmonary embolism. There is a limitation to perform a large-scaled randomized trial for these rare conditions, and several recommendations based on results of small-sized studies and observational registries are available now. Therefore, we need multi-department and international collaboration to test the efficacy and safety of anticoagulation including new oral anticoagulants in the treatment of venous thrombosis in atypical locations.
Anticoagulants ; Budd-Chiari Syndrome ; Cerebral Veins ; Cooperative Behavior ; Incidence ; Lower Extremity ; Pulmonary Embolism ; Registries ; Renal Veins ; Retinal Vein ; Splenic Vein ; Thrombosis ; Upper Extremity ; Upper Extremity Deep Vein Thrombosis ; Veins ; Venous Thrombosis*

We experienced a case of deep vein thrombosis after spine surgery in the prone position with a central venous catheter (CVC). Posterior lumbar interbody fusion was performed on a 73-year-old female patient who was diagnosed with spinal stenosis. Accordingly, in the operation room under general anesthesia, two-lumen CVC were inserted into the left subclavian vein. The surgery was performed in the prone position with a Wilson frame. On the next day, there was a sudden occurrence of severe edema in the patient's left arm. By ultrasonography and computed tomography scanning, extensive deep vein thrombosis was observed in the left subclavian vein. The existence of a factor affecting blood flow such as the prone position may increase the risk of thrombus formation. Therefore, careful perioperative evaluation should be implemented.
Aged ; Anesthesia, General ; Arm ; Catheterization* ; Catheters* ; Central Venous Catheters ; Edema ; Female ; Humans ; Prone Position* ; Spinal Stenosis ; Spine* ; Subclavian Vein ; Thrombosis ; Ultrasonography ; Upper Extremity Deep Vein Thrombosis ; Venous Thrombosis*

Adult ; Anticoagulants ; therapeutic use ; Heparin, Low-Molecular-Weight ; therapeutic use ; Humans ; Male ; Upper Extremity Deep Vein Thrombosis ; diagnosis ; drug therapy

A 21 year old male patient was admitted for pain, edema and a tingling sensation in his right arm. He underwent venography and an MRI scan, and he was diagnosed with Paget-Schroetter syndrome. Thoracoscopic first rib resection was performed after failure of thrombolytic therapy. The symptoms were relieved after the operation and he was discharged with warfarin medication. First rib resection is generally performed through the standard transaxillary or supraclavicular route. We report here on a successful thoracoscopic first rib resection.
Arm ; Edema ; Humans ; Magnetic Resonance Imaging ; Male ; Phlebography ; Ribs* ; Sensation ; Subclavian Vein ; Thoracoscopy ; Thrombolytic Therapy ; Thrombosis ; Upper Extremity Deep Vein Thrombosis ; Warfarin ; Young Adult