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Mota L, Tomeo JN, Yadavalli SD, Lee A, Liang P, Hamdan AD, Wyers MC, Schermerhorn ML, Stangenberg L. Management and Outcomes of Venous Thoracic Outlet Decompression: A Transition to the Infraclavicular Approach. J Vasc Surg Venous Lymphat Disord 2024:101959. [PMID: 39103050 DOI: 10.1016/j.jvsv.2024.101959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/15/2024] [Accepted: 07/20/2024] [Indexed: 08/07/2024]
Abstract
OBJECTIVE Venous thoracic outlet syndrome (vTOS) is caused by compression of the subclavian vein at the costoclavicular space, which may lead to vein thrombosis. Current treatment includes thoracic outlet decompression with or without venolysis. However, given its relatively low prevalence, the existing literature is limited. Here, we report our single institution experience in the treatment of vTOS. METHODS We performed a retrospective review of all patients who underwent rib resection for vTOS at our institution from 2007 to 2022. Demographic, procedural details, perioperative and long-term outcomes were reviewed. RESULTS A total of 76 patients were identified. The mean age was 36 years. Swelling was the most common symptom (93%), followed by pain (6.6%). 90% of patients had associated DVT, with 99% of these patients starting anticoagulation preoperatively. 91% of patients underwent rib resection via infraclavicular approach, 2% via paraclavicular approach (due to neurogenic component), and 7% via the transaxillary approach. Eighty-three percent of patients had endovascular intervention prior or at the time of the rib resection, with catheter-directed-thrombolysis (87%), followed by angioplasty (71%), and rheolytic thrombectomy (57%) being the most common interventions. Median time from endovascular intervention to rib resection was 14 days, with 25% at same admission. Median postoperative stay was 3 days (2-5). There was no perioperative mortality or nerve injury. Fourteen percent of patients had postoperative complications, with bleeding complications (12%) being the most common. Waiting more than 30 days between initial endovascular intervention and rib resection was not associated with decreased risk of bleeding complications. Patients were seen postoperatively at 1-month (physical exam) and 6-month (duplex) intervals or for any new or recurrent symptoms. Twenty-two percent of our overall patient population underwent reintervention, most commonly angioplasty (21%). At last follow-up, 97% of subclavian veins were patent, and 93% of patients were symptom-free. CONCLUSION Over the last decade we have transitioned to an infraclavicular approach for isolated vTOS, with low perioperative morbidity and good patency rates. These results support the adoption of the infraclavicular approach with adjunct endovascular techniques as a safe and efficacious treatment of vTOS.
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Affiliation(s)
- Lucas Mota
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston MA
| | - John N Tomeo
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston MA
| | - Sai Divya Yadavalli
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston MA
| | - Andy Lee
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston MA
| | - Patric Liang
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston MA
| | - Allen D Hamdan
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston MA
| | - Mark C Wyers
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston MA
| | - Marc L Schermerhorn
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston MA
| | - Lars Stangenberg
- Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston MA.
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Stojanovic N, Ukenenye E, Syed A. Innominate Vein Thrombosis: A Case Report and Literature Review. Cureus 2024; 16:e64145. [PMID: 39119383 PMCID: PMC11309737 DOI: 10.7759/cureus.64145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/10/2024] Open
Abstract
The brachiocephalic vein (BCV), also known as the innominate vein, is a central vein in the upper chest formed by merging the internal jugular and subclavian veins. It plays a crucial role in venous return from the head, neck, and upper extremities and is significant in procedures such as pacemaker and implantable cardioverter-defibrillator (ICD) placement, chemotherapy ports, and central venous catheter insertions. The presence of foreign bodies and local malignancy are major risk factors for thrombosis in the BCV. As part of the deep venous system, BCV thrombosis (BCVT) is a rare condition but can lead to serious complications like superior vena cava syndrome and, rarely, pulmonary embolism. This case report presents an 82-year-old woman with a history of heart failure with reduced ejection fraction, coronary artery disease, atrial fibrillation, HIV, pulmonary embolism, systemic lupus erythematosus, and breast cancer who required an ICD placement due to persistent systolic dysfunction. During the procedure, chronic BCVT leading to the stenosis was incidentally discovered, necessitating urgent vascular intervention to establish venous patency. The patient's complex medical history, including previous chemotherapy through a central venous catheter, contributed to the risk factors for BCVT. The multidisciplinary approach led to successful ICD placement and the reinstatement of anticoagulation therapy. This case underscores the rarity and severity of BCVT and highlights the importance of pre-procedural imaging, such as CT venography, in patients with multiple risk factors. Additionally, the report suggests considering leadless ICD technology for patients with limited venous access to avoid complications. The findings emphasize the critical need for thorough evaluation and planning in complex cases to ensure successful outcomes.
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Affiliation(s)
- Nikola Stojanovic
- Medicine, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Emmanuel Ukenenye
- Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Asma Syed
- Electrophysiology and Cardiology, Brookdale University Hospital and Medical Center, Brooklyn, USA
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3
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Cochran RL, Ghoshhajra BB, Hedgire SS. Body and Extremity MR Venography: Technique, Clinical Applications, and Advances. Magn Reson Imaging Clin N Am 2023; 31:413-431. [PMID: 37414469 DOI: 10.1016/j.mric.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Magnetic resonance venography (MRV) represents a distinct imaging approach that may be used to evaluate a wide spectrum of venous pathology. Despite duplex ultrasound and computed tomography venography representing the dominant imaging modalities in investigating suspected venous disease, MRV is increasingly used due to its lack of ionizing radiation, unique ability to be performed without administration of intravenous contrast, and recent technical improvements resulting in improved sensitivity, image quality, and faster acquisition times. In this review, the authors discuss commonly used body and extremity MRV techniques, different clinical applications, and future directions.
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Affiliation(s)
- Rory L Cochran
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Brian B Ghoshhajra
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sandeep S Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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Jenab Y, Tofighi S, Ayati A, Rezvanimehr A, Moosavi NS, Jalaie H, Barbati ME. Single-center experience with catheter-directed thrombolysis and balloon angioplasty for acute upper-extremity deep vein thrombosis: a case series study. BMC Cardiovasc Disord 2023; 23:351. [PMID: 37460994 DOI: 10.1186/s12872-023-03389-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Effective treatment of upper extremity deep vein thrombosis (UEDVT) is crucial to prevent further complications. Various treatments, including percutaneous mechanical thrombectomy (PMT), catheter-directed thrombolysis (CDT), decompression surgery, and venoplasty are suggested for UEDVT. However, no prospective study has yet favored any of these treatments. This study presents a review of our experience with CDT followed by balloon venoplasty in patients with acute primary UEDVT. METHODS We enrolled all patients diagnosed with acute UEDVT from January 2020 to June 2021. Subjects with UEDVT due to secondary causes like malignancies, indwelling catheters, or leads were excluded. CDT was performed through brachial vein access, using a perfusion catheter, and rt-PA administration. Balloon venoplasty was performed if the treated segment had remaining stenosis after CDT. Patients were followed up at the vein clinic for any signs and symptoms in the upper extremity and lifestyle changes. Follow-up ultrasonography was done 12 months after discharge. RESULTS Twelve patients with a mean age of 41.08 ± 14.0 years were included in the study. The mean duration of CDT was 25.00 ± 10.56 h. After CDT, all patients had remaining occlusions, with seven having more than 50% remaining stenosis. However, after balloon venoplasty, no patient had significant (more than 50%) stenosis. There was no serious complication after both procedures. Patients were followed up for a mean duration of twelve months after their admission, with a mean time of maintenance anticoagulation was 10.73 ± 5.77 months. Only one patient had recurrent symptoms in his target limb which required a decompression surgery, while the rest were free of symptoms in their treated extremity. No subject developed pulmonary emboli (PE) during admission or the follow-up period. There was no evidence of hospital readmission for any reason. Upper extremity color-doppler sonography of the patients at twelve months after their procedure showed normal venous flow without any significant stenosis in 8 (66.7%), and partially normal flow with patent target vein in 4 (33.3%) patients. CONCLUSIONS CDT followed by balloon venoplasty may be an effective treatment for selected patients with acute primary UEDVT, providing desirable long-term results and potentially avoiding the need for decompression surgery in the short or long term.
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Affiliation(s)
- Yaser Jenab
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Tofighi
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Aryan Ayati
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Rezvanimehr
- Faculty of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Najme-Sadat Moosavi
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Houman Jalaie
- Department of Vascular and Endovascular Surgery, University Hospital Aachen, Aachen, Germany
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Singh O, Juneja D. Upper extremity deep vein thrombosis: An intensivist’s perspective. World J Crit Care Med 2023; 12:130-138. [PMID: 37397592 PMCID: PMC10308337 DOI: 10.5492/wjccm.v12.i3.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 03/16/2023] [Accepted: 04/20/2023] [Indexed: 06/08/2023] Open
Abstract
Upper extremity deep vein thrombosis (UEDVT) is less common than lower extremity DVT but is a cause of significant morbidity and mortality in intensive care unit patients. Increasing cancer incidence, prolonged life expectancy and increasing use of intravascular catheters and devices has led to an increased incidence of UEDVT. It is also associated with high rates of complications like pulmonary embolism, post-thrombotic syndrome and recurrent thrombosis. Clinical prediction scores and D-dimer may not be as useful in identifying UEDVT; hence, a high suspicion index is required for diagnosis. Doppler ultrasound is commonly employed for diagnosis, but other tests like computed tomography and magnetic resonance imaging venography may also be required in some patients. Contrast venography is rarely used in patients with clinical and ultrasound findings discrepancies. Anticoagulant therapy alone is sufficient in most patients, and thrombolysis and surgical decompression is seldom indicated. The outcome depends on the cause and underlying comorbidities.
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Affiliation(s)
- Omender Singh
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
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Jaramillo N, Raidah A, Pradas KF, Lev S, Ramanathan A. Extensive Postpartum Upper and Lower Extremity Deep Vein Thrombosis in a Patient With a History of Preeclampsia. Cureus 2023; 15:e41109. [PMID: 37519553 PMCID: PMC10382326 DOI: 10.7759/cureus.41109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
We describe the case of a 19-year-old woman with no significant medical history who developed progressive right-sided neck pain and palpitations one month following a pregnancy complicated by preeclampsia. Family history was significant for unprovoked deep vein thrombosis (DVT) and pulmonary embolism (PE) in her father at age 44. Systemic examination revealed mild swelling of the right upper extremity with pain on palpation. Computed tomography (CT) of the thorax with contrast demonstrated extensive occlusion of right upper extremity veins and collateralization of chest wall veins. Pulmonary emboli were present bilaterally in the segmental and subsegmental branches of the lower lobe pulmonary arteries. CT of the abdomen with contrast revealed thrombi in the left common and external iliac veins. Thrombophilia screening was normal. The patient was treated with enoxaparin and ampicillin/sulbactam. Her clinical condition improved, and she was discharged with an outpatient clinic follow-up appointment.
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Affiliation(s)
- Nolberto Jaramillo
- Surgery, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Anisa Raidah
- Surgery, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | | | - Steven Lev
- Neuroradiology, Nassau University Medical Center, East Meadow, USA
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Schropp L, de Kleijn RJCMF, Westerink J, Nijkeuter M, Vonken EJ, van der Schaaf IC, Goedee HS, Vrancken AFJE, van Hattum ES, Petri BJ, de Borst GJ. Thoracic outlet syndrome (TROTS) registry: A study protocol for the primary upper extremity deep venous thrombosis section. PLoS One 2023; 18:e0279708. [PMID: 36608058 PMCID: PMC9821680 DOI: 10.1371/journal.pone.0279708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION There is a lack of comprehensive and uniform data on primary upper extremity deep venous thrombosis (pUEDVT). pUEDVT includes venous thoracic outlet syndrome related upper extremity deep venous thrombosis (UEDVT) and idiopathic UEDVT. Research on these conditions has been hampered by their rarity, lack of uniform diagnostic criteria, and heterogeneity in therapeutic strategies. To improve current research data collection using input of all various pUEDVT treating medical specialists, we initiated the ThoRacic OuTlet Syndrome (TROTS) registry. The aim of the TROTS registry is to a) collect extensive data on all pUEDVT patients through a predefined protocol, b) give insight in the long term outcome using patient reported outcome measures, c) create guidance in the diagnostic and clinical management of these conditions, and thereby d) help provide content for future research. METHODS AND ANALYSIS The TROTS registry was designed as an international prospective longitudinal observational registry for data collection on pUEDVT patients. All pUEDVT patients, regardless of treatment received, can be included in the registry after informed consent is obtained. All relevant data regarding the initial presentation, diagnostics, treatment, and follow-up will be collected prospectively in an electronic case report form. In addition, a survey containing general questions, a Health-related Quality of Life questionnaire (EQ-5D-5L), and Functional Disability questionnaire (Quick-DASH) will be sent periodically (at the time of inclusion, one and two years after inclusion, and every five years after inclusion) to the participant. The registry protocol was approved by the Medical Ethical Review Board and registered in the Netherlands Trial Register under Trial-ID NL9680. The data generated by the registry will be used for future research on pUEDVT and published in peer reviewed journals. CONCLUSION TROTS registry data will be used to further establish the optimal management of pUEDVT and lay the foundation for future research and guidelines.
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Affiliation(s)
- Ludo Schropp
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Jan Westerink
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
| | - Mathilde Nijkeuter
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Evert-Jan Vonken
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - H. Stephan Goedee
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexander F. J. E. Vrancken
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eline S. van Hattum
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart-Jeroen Petri
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gert J. de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
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8
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Schropp L, Cats RB, de Kleijn RJCMF, van Hattum ES, Middeldorp S, Nijkeuter M, Westerink J, Petri BJ, de Borst GJ. The upper extremity postthrombotic syndrome score: an international Delphi consensus study to determine the score's functional disability component. Res Pract Thromb Haemost 2023; 7:100051. [PMID: 36873563 PMCID: PMC9982296 DOI: 10.1016/j.rpth.2023.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/01/2022] [Accepted: 12/18/2022] [Indexed: 01/20/2023] Open
Abstract
Background In upper extremity thrombosis research, the occurrence of upper extremity postthrombotic syndrome (UE-PTS) is commonly used as the main outcome parameter. However, there is currently no reporting standard or a validated method to assess UE-PTS presence and severity. In a recent Delphi study, consensus was reached on a preliminary UE-PTS score, combining 5 symptoms, 3 signs, and the inclusion of a functional disability score. However, no consensus was reached on which functional disability score to be included. Objectives The aim of the current Delphi consensus study was to determine the specific type of functional disability score to finalize UE-PTS score. Methods This Delphi project was designed as a three-round study using open text questions, statements with 7-point Likert scales, and multiple-choice questions. The CREDES recommendations for Delphi studies were applied. In this context, a systematic review was conducted before the start of the Delphi rounds to identify the available functional disability scores as available in the literature and present these to the expert panel. Results Thirty-five of 47 initially invited international experts from multiple disciplines completed all the Delphi rounds. In the second round, consensus was reached on the incorporation of the quick disabilities of the arm, shoulder, and hand (QuickDASH) in the UE-PTS score, rendering the third round obsolete. Conclusion Consensus was reached that the QuickDASH should be incorporated in the UE-PTS score. The UE-PTS score will need to be validated in a large cohort of patients with upper extremity thrombosis before it can be used in clinical practice and future research.
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Affiliation(s)
- Ludo Schropp
- Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands
| | - Roos B Cats
- Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands
| | | | - Eline S van Hattum
- Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands
| | - Saskia Middeldorp
- Department of Internal Medicine & Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mathilde Nijkeuter
- Department of Internal Medicine, University Medical Center Utrecht, The Netherlands
| | - Jan Westerink
- Department of Internal Medicine, Isala Hospital, Zwolle, The Netherlands
| | - Bart-Jeroen Petri
- Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, The Netherlands
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Leão RV, Bernal ECBA, Rodrigues MB, Amaral DT, de Paula Correa MF, Helito PVP. Venous thrombosis: a mimic of musculoskeletal injury on MR imaging. Skeletal Radiol 2022; 52:1263-1276. [PMID: 36534142 DOI: 10.1007/s00256-022-04258-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/06/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
Clinical signs and symptoms of venous thrombosis and musculoskeletal pathologies frequently overlap. Sometimes, patients with venous thrombosis undergo MR examinations under an equivocal suspicion of muscle, tendon or articular injury. A low pretest clinical suspicion and lack of familiarity with the conventional MR imaging signs of venous thrombosis may result in failure to diagnose venous thrombosis, delaying treatment and raising morbimortality. In MR imaging, thrombosis presents as venous ectasia with intraluminal heterogeneous content. Small vein thrombosis is often identified as having a branching aspect. Perivenous edema and inflammatory soft tissue changes may be the most prominent findings. The purpose of this paper is to illustrate MR findings of venous thrombosis in patients who underwent MR examinations due to suspected musculoskeletal pathologies. Cases of venous thrombosis in different sites of the body diagnosed through MR are presented.
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Affiliation(s)
- Renata Vidal Leão
- Department of Radiology, Hospital Sírio-Libanês, R. Adma Jafet, 91, São Paulo, 01308-050, Brazil.
| | | | | | - Denise Tokechi Amaral
- Department of Radiology, Hospital Sírio-Libanês, R. Adma Jafet, 91, São Paulo, 01308-050, Brazil
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de Boer M, Shiraev T, Saha P, Dubenec S. Medium Term Outcomes of Deep Venous Stenting in the Management of Venous Thoracic Outlet Syndrome. Eur J Vasc Endovasc Surg 2022; 64:712-718. [PMID: 36028006 DOI: 10.1016/j.ejvs.2022.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Venous thoracic outlet syndrome (vTOS) is a relatively rare condition associated with significant morbidity. Its management continues to evolve, with increasing use of endovascular adjuncts, such as percutaneous thrombectomy and angioplasty, in addition to first rib resection. The utility of stenting residual venous stenotic lesions is poorly defined within the literature. This study sought to review the medium term patency rates of upper limb deep venous stenting in the management of vTOS. METHODS A single centre, retrospective review of patients managed for vTOS with first rib resection followed by upper limb deep venous stenting between January 2012 and February 2021 was conducted. Post-procedural ultrasounds were reviewed to determine stent patency. RESULTS Twenty-six patients were included, with 33 stents placed. The median duration of follow up was 50 months. On venous duplex ultrasound at three years post-operatively, primary patency rates were 66%, primary assisted patency rates were 88%, secondary patency rates were 91%, and total occlusion rates were 9%. After stent placement, 80% of patients remained asymptomatic with regard to compression symptoms. CONCLUSION Upper limb deep venous stenting is an effective adjunct to surgical decompression in the management of vTOS. Stent medium term patency rates are promising; however, further studies with longer follow up and larger cohorts with multicentre results are required to confirm these early findings.
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Affiliation(s)
- Madeleine de Boer
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
| | - Timothy Shiraev
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Prakash Saha
- Academic Department of Surgery, School of Cardiovascular Medicine & Sciences, British Heart Foundation of Research Excellence, King's College London, London, UK
| | - Steven Dubenec
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
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Miret-Salvador M, Hernández-Taboas L, Espinosa-Urbina R. Trombosis venosa profunda de miembro superior. Semergen 2022; 48:364-366. [DOI: 10.1016/j.semerg.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/19/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022]
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Suwal A, Rijal SS, Shrestha M, Munankami S, Basnet S. Paget-Schroetter Syndrome: A Rare Case of Upper Extremity Deep Vein Thrombosis in a Young Swimmer. Cureus 2022; 14:e26060. [PMID: 35865424 PMCID: PMC9293272 DOI: 10.7759/cureus.26060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2022] [Indexed: 11/06/2022] Open
Abstract
Paget-Schroetter syndrome (PSS) is a rare form of spontaneous upper extremity deep vein thrombosis associated with vigorous activity of the upper extremities. We present a rare case of a young swimmer who presented with a painful right upper extremity swelling, with compression ultrasound (CUS) revealing extensive venous clots in the basilic, axillary, and subclavian veins. Venous duplex revealed extrinsic compression of the subclavian vein, and catheter-based contrast venography confirmed our diagnosis of PSS. The patient was started on a therapeutic dose of subcutaneous enoxaparin and referred to a higher center for further intervention.
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13
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Incidence of upper extremity deep vein thrombosis in the retrosternal reconstruction after esophagectomy. BMC Surg 2022; 22:91. [PMID: 35264138 PMCID: PMC8908570 DOI: 10.1186/s12893-022-01544-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background Upper extremity deep vein thrombosis (UEDVT) is relatively rare but cannot be negligible because it can cause fatal complications. Although it is reported that the occurrence rate of UEDVT has increased due to central venous catheter (CVC), cancer, and surgical invasion, there is still limited information for esophagectomy. The aim of this study was to evaluate the clinical factors, including CVC placement and thromboprophylaxis approach, as well as retrosternal space’s width as a predictive factor for UEDVT in patients receiving esophagectomy. Methods This study included 66 patients who underwent esophagectomy with retrosternal reconstruction using a gastric tube. All patients routinely underwent contrast-enhanced computed tomography (CT) on the 4th postoperative day. Low-molecular-weight-heparin (LMWH) was routinely administered by the 2nd postoperative day. To evaluate retrosternal space’s width, (a) The distance from sternum to brachiocephalic artery and (b) the distance from sternum to vertebra were measured by preoperative CT, and the ratio of (a) to (b) was defined as the width of retrosternal space. Results Among all patients, 11 (16.7%) suffered from UEDVT, and none was preoperatively received CVC placement, while 7 were inserted in non-UEDVT cases. Retrosternal space’s width in patients with UEDVT was significantly smaller than that in patients without UEDVT (0.17 vs. 0.26; P < 0.0001). A cutoff value of the width was 0.21, which has high sensitivity (87%) and specificity (82%) for UEDVT prediction, respectively. Conclusion The existence of CVC may not affect the development of UEDVT, but preoperative evaluation of retrosternal ratio may predict the occurrence of UEDVT.
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Ishizuka K, Katayama K, Kaji Y, Tawara J, Ohira Y. Paget-Schroetter syndrome. QJM 2022; 115:54-55. [PMID: 34865158 DOI: 10.1093/qjmed/hcab293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- K Ishizuka
- Department of General Medicine, International University of Health and Welfare Narita Hospital, 852, Hatakeda, Narita-city, Chiba Prefecture, Japan
| | - K Katayama
- Department of General Medicine, International University of Health and Welfare Narita Hospital, 852, Hatakeda, Narita-city, Chiba Prefecture, Japan
| | - Y Kaji
- Department of General Medicine, International University of Health and Welfare Narita Hospital, 852, Hatakeda, Narita-city, Chiba Prefecture, Japan
| | - J Tawara
- Department of General Medicine, International University of Health and Welfare Narita Hospital, 852, Hatakeda, Narita-city, Chiba Prefecture, Japan
| | - Y Ohira
- Department of General Medicine, International University of Health and Welfare Narita Hospital, 852, Hatakeda, Narita-city, Chiba Prefecture, Japan
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15
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Zosel KL, Dummar MK, Adams BG, Henderson NC, Westrick RB. Upper Extremity Superficial Vein Thromboses Presenting as Acute Neck Pain in a Young and Healthy Male: A Case Report. Int J Sports Phys Ther 2021; 16:854-861. [PMID: 34123537 PMCID: PMC8169024 DOI: 10.26603/001c.23429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Neck pain in the United States is pervasive and contributes to disability. While the majority of neck pain in young and healthy individuals is neuromusculoskeletal in nature, screening for red flags is necessary for ruling-out serious medical pathologies. The purpose of this case report is to describe a young and healthy male subject with a primary complaint of acute neck pain with multiple underlying upper extremity superficial vein thromboses (UESVTs). CASE DESCRIPTION The subject was a 27-year-old male active-duty Soldier referred to physical therapy by his primary care provider (PCP) for acute left-sided neck pain. Prior to physical therapy, the subject had been treated with cyclobenzaprine, oxycodone-acetaminophen, trigger point injection and had undergone a D-dimer to rule out a potential thrombus due to air travel and lower extremity immobilization. OUTCOMES The subject underwent a D-dimer, Doppler ultrasound, pharmacological treatment of Rivaroxaban, and was referred to hematology/oncology to rule out systemic causes of SVTs. Evidence of subtle increases in blood pressure over the course of three months, a positive D-dimer, and symptoms incongruent with clinical presentation contributed to referral to a hematology/oncology specialist and a diagnosis of multiple UESVTs. The subject was able to return to his previous level of activity by six months and remained free of SVTs at two-year follow-up. DISCUSSION UESVT events are rare and can be challenging to identify. This case report describes a unique presentation of acute neck pain caused by underlying UESVTs in an otherwise healthy and active young male. LEVEL OF EVIDENCE Level 4.
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16
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Bertino FJ, Shin DS, Monroe EJ, Siu JJ, Tenen CC, Chick JFB. Thrombectomy of Malignant Thoracic Central Venous Occlusive Disease Using Inari ClotTriever System. J Vasc Interv Radiol 2021; 32:1398-1400. [PMID: 34062273 DOI: 10.1016/j.jvir.2021.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/19/2021] [Accepted: 05/23/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Frederic J Bertino
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195
| | - David S Shin
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195
| | - Eric J Monroe
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195
| | - Jason J Siu
- Department of Laboratory Medicine and Pathology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195
| | - Claudia C Tenen
- Department of Laboratory Medicine and Pathology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195
| | - Jeffrey Forris Beecham Chick
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195
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Reconsidering the Role of Routine Anticoagulation for Venous Thromboembolism Prevention in Plastic Surgery. Ann Plast Surg 2021; 85:97-99. [PMID: 31809477 PMCID: PMC7363439 DOI: 10.1097/sap.0000000000002162] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Badesha AS, Singh Bains PR, Singh Bains BR, Khan T. A systematic review and meta-analysis of the treatment of obstructive chronic deep venous disease using dedicated venous stents. J Vasc Surg Venous Lymphat Disord 2021; 10:267-282.e4. [PMID: 33965610 DOI: 10.1016/j.jvsv.2021.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/18/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES This review aims to summarise the efficacy and safety of dedicated venous stenting for the treatment of obstructive chronic deep venous disease. The approaches to stenting and post-procedural management of different vascular units are also highlighted. METHODS MEDLINE and Embase were searched to identify relevant literature on dedicated venous stents published from January, 2010 to May, 2020. The patient population and study characteristics; procedural characteristics; and outcomes related to post-stenting symptoms, health-related quality of life, patency and complications were analysed. RESULTS Sixteen single-arm observational studies were included from 2,366 studies identified from key-word searches. In total, 1,688 patients were included, of which 70.5% had post-thrombotic syndrome and the remainder had non-thrombotic iliac vein lesions. Nine studies (n = 848), stated whether lesions were stenotic (36.6%) or occlusive (63.4%). Seven studies did not report the lesion characteristics (n = 840). Eight different dedicated venous stent brands were employed. 73.4% of ulcers healed at last follow-up. The remaining symptomatic changes were described narratively; sustained improvements in pain, venous claudication and oedema following stenting were observed. Significant post-stenting improvements in health-related quality of life were noted, as measured by the Chronic Venous Insufficiency Questionnaire-20 instrument. Overall, the most frequently reported complications were in-stent occlusion (n = 204), in-stent stenosis (n = 149) and minor bleeding (n = 77). At 12 months, the primary patency ranged from 59% to 94%, whilst the secondary patency ranged 87% to 100%. The pooled-primary and secondary stent patency rates at 12 months were 74.0% and 90.4%, respectively. The incidence of major and minor bleeding was 1.9% and 4.7%, respectively; bleeding complications were more common in patients undergoing hybrid intervention. CONCLUSION Deep venous stenting using dedicated venous stents is a safe technique to treat obstructive chronic deep venous disease and within the limitations of this study, is associated with good patency outcomes and symptomatic improvement.
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Affiliation(s)
- Arshpreet Singh Badesha
- Manchester Medical School, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom.
| | - Prab Rajan Singh Bains
- Manchester Medical School, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Bal Rajan Singh Bains
- Manchester Medical School, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Taha Khan
- Manchester Vascular Service, Manchester, United Kingdom
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19
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Dhami SPS, Patmore S, O'Sullivan JM. Advances in the Management of Cancer-Associated Thrombosis. Semin Thromb Hemost 2021; 47:139-149. [PMID: 33636745 DOI: 10.1055/s-0041-1722863] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The association between cancer and venous thromboembolism (VTE) has been established for more than 150 years. Nevertheless, cancer-associated thrombosis still remains a major clinical challenge and is associated with significant morbidity and mortality for patients with cancer. The clinical presentation of cancer-associated thrombosis can be distinct from that of a patient without an underlying malignancy. Moreover, specific cancer types, including pancreatic cancer and hematological malignancies, as well as advanced stage disease can confer a significant thrombotic risk. This risk is further augmented by specific anticancer treatment modalities. The pathophysiology of cancer-associated thrombosis is complex and multifactorial. However, understanding the biological mechanisms underpinning VTE risk may provide insight into novel targeted prophylaxis in cancer patients. Over the last decade, low-molecular-weight heparin has been the preferred anticoagulant agent for patients with cancer-associated thrombosis due to improved efficacy compared with vitamin K antagonists. However, the advent of direct oral anticoagulants (DOACs) has added to the repertoire of ammunition now at the disposal of clinicians to aid in the management of cancer-associated thrombosis. Several randomized controlled trials have now been published, demonstrating DOAC as a noninferior alternative for both the treatment and prevention of cancer-associated thrombosis. Notwithstanding this, limitations for their widespread use remain, with the potential for increased bleeding risk, drug interactions, and poor DOAC metabolism. This review discusses the evidence base for the incidence and risk factors associated with VTE in cancer, development, and refinement of risk prediction models and novel advances in the therapeutic management of cancer-associated thrombosis.
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Affiliation(s)
- Sukhraj Pal Singh Dhami
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Sean Patmore
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Jamie M O'Sullivan
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
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20
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Kumar V, Kumar Nayak P, Singh Yadav M, Dhir S, Arora V, Kumar V. Alternate method for endocardial pacemaker lead implantation: A hybrid mini-thoracotomy approach. Indian Pacing Electrophysiol J 2021; 21:178-181. [PMID: 33493671 PMCID: PMC8116752 DOI: 10.1016/j.ipej.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/16/2021] [Accepted: 01/17/2021] [Indexed: 11/29/2022] Open
Abstract
Although the conventional methods for endo-cardial pacemaker lead implantation via subclavian or cephalic or axillary vein routes is common, but sometimes due to anatomical variations it is not feasible to access these veins Emergence of newer techniques are useful for lead implantation. This case report focuses on a hybrid approach of combined mini-thoracotomy for endocardial pacemaker lead implantation. This fluoroscopy guided minimal thoracotomy approach with endocardial MRI compatible lead placement had the benefits of simple procedural, minimal hospital stay, low early complication rates and economically viable to the patient.
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Affiliation(s)
- Viveka Kumar
- Department of Cardiology, Max Superspeciality Hospital, New Delhi, India.
| | | | | | - Sangeeta Dhir
- Department of Cardiology, Max Superspeciality Hospital, New Delhi, India.
| | - Vanita Arora
- Director & Head Electrophysiology, Max Superspeciality Hospital, New Delhi, India.
| | - Vivek Kumar
- Department of Cardiology, Max Superspeciality Hospital, New Delhi, India.
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21
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Abstract
Focusing on the current state of the art, this article (a) describes recent advances in the understanding of the pathogenesis of venous thromboembolism (VTE), (b) discusses current approaches for the prevention, diagnosis and treatment of VTE, (c) outlines the role of aspirin for VTE prevention and treatment, and (d) highlights the unmet needs in VTE management and describes novel approaches to address them.
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Affiliation(s)
- Noel C Chan
- Thrombosis and Atherosclerosis Research Institute and McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey I Weitz
- Thrombosis and Atherosclerosis Research Institute and McMaster University, Hamilton, Ontario, Canada
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22
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Beiswenger AC, Quereshy HA, Rouabhi M, Harth KC, Azim AA, Janko MR, Shevitz AJ, Bose S, Cho JSS, Kashyap VS. Midterm outcomes in patients with upper extremity deep vein thrombosis. J Vasc Surg Venous Lymphat Disord 2020; 8:930-938.e2. [PMID: 32457023 DOI: 10.1016/j.jvsv.2020.02.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Outcomes and the necessity for anticoagulation in patients with upper extremity deep vein thrombosis (UE DVT) are unclear. The purpose of this study was to determine the incidence of UE DVT, the outcomes of patients stratified by anticoagulation treatment, and which factors were significantly associated with mortality. METHODS This study was a single-center, retrospective review of all patients undergoing UE venous duplex imaging in 2016. Information on patients' demographics, relevant comorbidities, use of anticoagulation at the time of diagnosis, characteristics of the UE DVT, treatment regimen(s), and outcomes was collected. Data were analyzed using descriptive and univariate statistics; multivariate logistic regression and Cox proportional hazard models were used to identify which of the aforementioned covariates are significantly associated with mortality rates at 30 days and 6 months, respectively, at a 95% confidence level. RESULTS Of the 911 patients undergoing UE venous duplex imaging, 182 (20.0%) were positive for UE DVT. Within the first 30 days, 30 patients (16.5%) died, 13 (7.1%) had pulmonary emboli, 42 (23.1%) had either pulmonary emboli or died, and 3 (1.6%) had ischemic strokes. Within the first 6 months, 50 patients (27.5%) died. The mortality rate at 30 days was found to be significantly increased in patients who were older (odds ratio [OR], 1.06; P < .01), had high-risk contraindications to anticoagulation (OR, 5.14; P < .01), were on dialysis (OR, 3.03; P = .04), had centrally located UE DVTs (OR, 2.72; P < .05), and had a stroke (OR, 20.34; P = .03). Mortality was significantly decreased in patients who were treated with anticoagulation (OR, 0.16; P < .05). At 6 months, however, age (hazard ratio [HR], 1.05; P < .001), male sex (HR, 2.16; P = .02), dialysis (HR, 2.90; P = .01), high-risk contraindications to anticoagulation (HR, 2.67; P = .02), UE DVTs in both central and peripheral veins (HR, 4.55; P = .03), and ischemic stroke in the first 30 days (HR, 71.63; P < .001) were associated with significant increases in mortality. CONCLUSIONS These data suggest that mortality rates among patients with UE DVT are relatively high and that treatment with anticoagulation is associated with a decrease in mortality at 30 days. Mortality was also associated with multiple comorbid conditions and demographics and not necessarily venous thromboembolism.
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Affiliation(s)
| | | | - Mohamed Rouabhi
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Karem C Harth
- The Vascular Center, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Anas Abdel Azim
- The Vascular Center, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Matthew R Janko
- The Vascular Center, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Andrew J Shevitz
- William Carey University College of Osteopathic Medicine, Hattiesburg, Miss
| | - Saideep Bose
- The Vascular Center, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jae-Sung S Cho
- The Vascular Center, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Vikram S Kashyap
- The Vascular Center, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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Timing of Thoracic Outlet Decompression after Thrombolysis for Primary Upper Extremity Deep Venous Thrombosis: A Systematic Review. Ann Vasc Surg 2020; 66:654-661. [PMID: 32035261 DOI: 10.1016/j.avsg.2020.01.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/24/2020] [Accepted: 01/26/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The optimal timing of decompression surgery after thrombolysis in patients with primary upper extremity deep vein thrombosis (UEDVT) is still a matter of debate. This systematic review compares the safety and efficacy of early intervention versus postponed intervention in patients with primary UEDVT. METHODS A structured PUBMED, EMBASE, and COCHRANE search was performed for studies reporting on the timing of surgical intervention for primary UEDVT. Studies reporting on timing of decompression surgery in combination with recurrent thrombosis, bleeding complications, and symptom-free survival were included. Two treatment groups were defined; group A received surgical decompression within two weeks after thrombolysis and group B after two weeks or more. All end points were assessed in accordance with the reported outcomes in the included articles. Mean percentages were calculated using descriptive statistics. RESULTS Six articles (126 patients) were included: 87 patients in group A versus 39 in group B. In group A, bleeding complications occurred in 7% of patients versus 5% in group B. Two-third of the bleeding complications in group A occurred in patients receiving surgical decompression within 24 hr after thrombolysis while kept on intravenous heparin both preoperatively and postoperatively. Reported preoperative recurrent thrombosis was 7% in group A versus 11% in group B, another 13% had postoperative recurrent thrombosis versus 21% in group B. The effectiveness of both treatment strategies was comparable with a total of 89% of patients in group A with minimal or no symptoms at final follow-up compared with 90% in group B. The mean follow-up in group A was 35 months (1-168 months) and 28 months (1-168 months) in group B. CONCLUSIONS Based on the limited available data presented in this review, early decompression surgery within two weeks after catheter-directed thrombolysis seems as safe and effective as postponed surgical intervention in patients with primary UEDVT.
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Algoblan D, AlAitah L, Alotaibi AM. Internal Jugular and Subclavian Vein Thrombosis in a Post-liver Transplant Patient. Cureus 2020; 12:e6557. [PMID: 31942270 PMCID: PMC6942507 DOI: 10.7759/cureus.6557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Internal jugular vein thrombosis (IJVT) is an unusual case of vascular disease of the upper limb veins, that could result in multiple complications if left untreated. IJVT can be subdivided into primary and secondary. Primary IJVT is when the thrombosis happens to someone without known risk factors, while secondary IJVT is when it happens to a person with previous risk factors. Our patient is a 66-year-old male with a history of hypertension and is status post-liver transplant in 2014 due to end-stage liver disease; he presented to the emergency department of the King Faisal Specialist Hospital & Research Center complaining of progressive right chest, flank, and back pain for the past month. On physical examination, the patient had right upper limb, chest, and neck increase in vascular markings and right supraclavicular swelling with no erythema. Upper extremity and neck ultrasound showed positive deep vein thrombosis (DVT) of the right internal jugular vein, right subclavian vein, and axillary vein. A chest X-ray showed right-sided pleural effusion with no mediastinal shift. Computer tomography (CT) demonstrated thrombosed right internal jugular and subclavian veins. General internal medicine service was consulted and they started the patient on Emxparine 1 mg/kg twice daily. The patient improved and is doing fine. He is scheduled for repeated outpatient follow-ups.
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Affiliation(s)
| | | | - Abdullah M Alotaibi
- Emergency Medicine, King Faisal Specialist Hosptial and Research Center, Riyadh, SAU
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Yoo T, Aggarwal R, Brathwaite S, Satiani B, Haurani MJ. Four-extremity venous duplex ultrasound for suspected deep venous thrombosis is an anachronism. J Vasc Surg Venous Lymphat Disord 2019; 7:325-332.e1. [PMID: 30885630 DOI: 10.1016/j.jvsv.2018.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/02/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Duplex ultrasound is the "gold standard" for diagnosis of acute deep venous thrombosis (DVT) because of its high specificity, sensitivity, safety, and portability. However, unnecessary testing epitomizes inefficient use of scarce health care resources. Here we hypothesize that the majority of simultaneous four-extremity duplex ultrasound (FED) examinations are unnecessary. By analyzing clinical factors of patients with acute DVT found on FED, we aimed to identify a subset of high-risk patients who may have a valid indication for four-extremity testing. METHODS We retrospectively reviewed all venous duplex ultrasound examinations performed in our Intersocietal Accreditation Commission-accredited vascular laboratory from January 1, 2009, to December 31, 2016. Patients with duplex ultrasound scans of all four limbs were included. DVT risk factors and indication for duplex ultrasound examination were recorded. The primary outcome was finding of acute DVT. RESULTS There were 188 patients who met our search criteria, of whom 31 patients (16.5%) had acute DVT (11 upper extremity, 16 lower extremity, and 4 upper and lower extremity). Fever of unknown origin (FUO) was the main indication for requesting FED (53.7%). Patients who underwent FED for FUO had a significantly lower likelihood of DVT (odds ratio, 0.21; P = .01). DVT was rarely the proximate cause (<1% of all cases) as follow-up culture results and clinical course most often revealed other sources of fever. Only patients with an upper extremity central venous catheter (CVC; n = 103) with at least two associated risk factors had an upper extremity DVT, which was usually line associated (93%). Only patients with at least two associated risk factors had a lower extremity DVT. CONCLUSIONS FED for FUO is inefficient, given that DVT was rarely the proximate cause of fever. Acute upper extremity DVT was found only in patients with an upper extremity CVC, demonstrating that patients without upper extremity CVC do not benefit from upper extremity duplex ultrasound examination. Upper extremity DVT is usually line associated and dependent on the number of cumulative risk factors present, suggesting that only the extremity associated with the CVC in the right clinical context should be imaged. Lower extremity DVT is also dependent on the number of cumulative risk factors present, and testing should be reserved for patients according to the clinical context. Our results indicate that a restrictive strategy can reduce testing inefficiency and health care cost without compromising patients' safety.
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Affiliation(s)
- Taehwan Yoo
- Division of Vascular Disease and Surgery, Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Rishav Aggarwal
- Division of Vascular Disease and Surgery, Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Shayna Brathwaite
- Division of Vascular Disease and Surgery, Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Bhagwan Satiani
- Division of Vascular Disease and Surgery, Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Mounir J Haurani
- Division of Vascular Disease and Surgery, Department of Surgery, The Ohio State University, Columbus, Ohio.
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26
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Retrosternal goiter presenting as deep vein thrombosis of the arm. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:309-311. [PMID: 30880038 DOI: 10.1016/j.anorl.2017.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 11/06/2017] [Accepted: 11/13/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Deep vein thrombosis of the upper-extremity (ueDVT) is often caused by trauma to the subclavian vein, central venous line and hypercoagulation disorders. CASE REPORT We present a case of a ueDVT due to retrosternal goiter compressing the right brachiocephalic vein. Low molecular weight heparin was initiated subcutaneously and fluid was aspirated from the thyroid cyst causing an immediate improvement. Cytology detected no malignancy. At eight-month follow-up, the patient showed complete resolution of her symptoms. DISCUSSION In general, the optimal treatment should include removal of the compressing thyroid. In co-morbid patients and a dominant thyroidal cyst, thyroid aspiration may be sufficient.
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Wooster M, Fernandez B, Summers KL, Illig KA. Surgical and endovascular central venous reconstruction combined with thoracic outlet decompression in highly symptomatic patients. J Vasc Surg Venous Lymphat Disord 2019; 7:106-112.e3. [DOI: 10.1016/j.jvsv.2018.07.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/31/2018] [Indexed: 10/27/2022]
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Miller MJ, Stokes LS, Abboud R, Bhatti Z, Pillai AK. Percutaneous Venous Interventions in The Pulmonary Vascular, Central and Peripheral Venous Systems: How to Recognize, Avoid and Treat Complications. Tech Vasc Interv Radiol 2018; 21:228-241. [PMID: 30545501 DOI: 10.1053/j.tvir.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Endovascular treatment of venous disease encompasses a broad range of interventions. Both central and peripheral venous interventions can range from the simple to the complex which increases the need for proper patient selection, procedural planning and technical proficiency. The following article will discuss the importance of avoiding, recognizing and addressing complications associated with venous interventions. Our goal is to raise awareness and educate to help the reader improve performance.
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Affiliation(s)
- Michael J Miller
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC.
| | - LeAnn S Stokes
- Department of Radiology, Vanderbilt University Medical Center, TN.
| | - Rayan Abboud
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC.
| | - Zagum Bhatti
- Department of Diagnostic Imaging and Intervention, University of Texas, Houston, TX.
| | - Anil K Pillai
- University of Texas, Health Science Center, Houston, TX.
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Shatzel JJ, O'Donnell M, Olson SR, Kearney MR, Daughety MM, Hum J, Nguyen KP, DeLoughery TG. Venous thrombosis in unusual sites: A practical review for the hematologist. Eur J Haematol 2018; 102:53-62. [PMID: 30267448 DOI: 10.1111/ejh.13177] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 12/13/2022]
Abstract
Thrombosis of unusual venous sites encompasses a large part of consultative hematology and is encountered routinely by practicing hematologists. Contrary to the more commonly encountered lower extremity venous thrombosis and common cardiovascular disorders, the various thromboses outlined in this review have unique presentations, pathophysiology, workup, and treatments that all hematologists should be aware of. This review attempts to outline the most up to date literature on cerebral, retinal, upper extremity, hepatic, portal, splenic, mesenteric, and renal vein thrombosis, focusing on the incidence, pathophysiology, provoking factors, and current recommended treatments for each type of unusual thrombosis to provide a useful and practical review for the hematologist.
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Affiliation(s)
- Joseph J Shatzel
- Division of Hematology-Oncology, Oregon Health & Science University, Portland, Oregon
| | - Matthew O'Donnell
- Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon
| | - Sven R Olson
- Division of Hematology-Oncology, Oregon Health & Science University, Portland, Oregon
| | - Matthew R Kearney
- Department of Internal Medicine, Oregon Health & Science University, Portland, Oregon
| | - Molly M Daughety
- Division of Hematology-Oncology, Oregon Health & Science University, Portland, Oregon
| | - Justine Hum
- Division of Gastroenterology, Oregon Health & Science University, Portland, Oregon
| | - Khanh P Nguyen
- Division of Vascular Surgery, Oregon Health & Science University, Portland, Oregon
| | - Thomas G DeLoughery
- Division of Hematology-Oncology, Oregon Health & Science University, Portland, Oregon
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30
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Delluc A, Le Mao R, Tromeur C, Chambry N, Rault-Nagel H, Bressollette L, Mottier D, Couturaud F, Lacut K. Incidence of upper-extremity deep vein thrombosis in western France: a community-based study. Haematologica 2018; 104:e29-e31. [PMID: 30076179 DOI: 10.3324/haematol.2018.194951] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Aurélien Delluc
- EA 3878 (GETBO), Brest University, France .,Division of Clinical Hematology, the Ottawa Hospital Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Canada
| | - Raphaël Le Mao
- EA 3878 (GETBO), Brest University, France.,Department of Vascular Medicine, Internal Medicine, and Chest Diseases, Hôpital de la Cavale Blanche, 29609 Brest Cedex, France
| | - Cécile Tromeur
- EA 3878 (GETBO), Brest University, France.,Department of Vascular Medicine, Internal Medicine, and Chest Diseases, Hôpital de la Cavale Blanche, 29609 Brest Cedex, France
| | | | | | - Luc Bressollette
- EA 3878 (GETBO), Brest University, France.,Department of Vascular Medicine, Internal Medicine, and Chest Diseases, Hôpital de la Cavale Blanche, 29609 Brest Cedex, France
| | - Dominique Mottier
- EA 3878 (GETBO), Brest University, France.,INSERM CIC 1412, Hôpital de la Cavale Blanche, 29609 Brest Cedex, France
| | - Francis Couturaud
- EA 3878 (GETBO), Brest University, France.,Department of Vascular Medicine, Internal Medicine, and Chest Diseases, Hôpital de la Cavale Blanche, 29609 Brest Cedex, France.,INSERM CIC 1412, Hôpital de la Cavale Blanche, 29609 Brest Cedex, France
| | - Karine Lacut
- EA 3878 (GETBO), Brest University, France.,Department of Vascular Medicine, Internal Medicine, and Chest Diseases, Hôpital de la Cavale Blanche, 29609 Brest Cedex, France
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Saranteas T, Mavrogenis AF, Poularas J, Kostroglou A, Mandila C, Panou F. Cardiovascular ultrasonography detection of embolic sources in trauma. J Crit Care 2018; 45:215-219. [PMID: 29579573 DOI: 10.1016/j.jcrc.2018.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 01/28/2018] [Accepted: 03/16/2018] [Indexed: 11/29/2022]
Abstract
Venous thromboembolism (deep vein thrombosis and pulmonary embolism) and bone cement implantation syndrome are major sources of embolic events in trauma patients. In these patients, embolic events due to venous thromboembolism and bone cement implantation syndrome have been detected with cardiac and vascular ultrasonography in the emergency setting, during the perioperative period, and in the intensive care unit. This article discusses the ultrasonography modalities and imaging findings of embolic events related to venous thromboembolism and bone cement implantation syndrome. The aim is to present a short review with exceptional illustrations that can enable physicians to identify sources of emboli in trauma patients with cardiovascular ultrasonography.
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Affiliation(s)
- Theodosios Saranteas
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | - John Poularas
- Intensive Care Unit, General State Hospital of Athens, G. Gennimatas, Athens, Greece
| | - Andreas Kostroglou
- Second Department of Anesthesiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Christina Mandila
- Intensive Care Unit, General State Hospital of Athens, G. Gennimatas, Athens, Greece
| | - Fotios Panou
- Second Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Catheter-Directed Thrombolysis Versus Pharmacomechanical Thrombectomy for Upper Extremity Deep Venous Thrombosis: A Cost-Effectiveness Analysis. Ann Vasc Surg 2018. [PMID: 29522873 DOI: 10.1016/j.avsg.2018.01.104] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Upper extremity deep vein thrombosis represents (UEDVT) 2-3% of all deep vein thrombosis. Catheter directed thrombolysis (CDT) was replaced largely by pharmacomechanical thrombolysis (PMT) in our institution. In this study we compared the immediate and 1-year results as well as the total hospital costs between CDT and PMT in the treatment of UEDVT. METHODS From 2006 to 2013, 55 patients with UEDVT were treated with either CDT or PMT at Helsinki University Hospital. Of them, 43 underwent thoracoscopic rib resection later to relieve phlebography-confirmed vein compression. This patient cohort was prospectively followed up with repeated phlebographies. CDT was performed to 24 patients, and 19 had PMT with a Trellis™ device. Clinical evaluation and vein patency assessment were performed with either phlebography or ultrasound 1 year after the thrombolysis. Primary outcomes were immediate technical success, 1-year vein patency, and costs of the initial treatment. RESULTS The immediate overall technical success rate, defined as recanalization of the occluded vein and removal of the fresh thrombus, was 91.7% in the CDT group and 100% in the PMT group (n.s.). The median thrombolytic time was significantly longer in CDT patients than that in PMT patients (21.1 vs. 0.33 hr, P < 0.00001). There were no procedure-related complications. The 1-year primary assisted patency rate was similar in both the groups (91.7% and 94.7%). There were no recurrences of clinical DVT. The hospital costs for the acute period were significantly lower in the PMT group than those in the CDT group (medians: 11,476 € and 5,975 € in the CDT and PMT groups, respectively [P < 0.00001]). CONCLUSIONS The clinical results of the treatment of UEDVT with CDT or PMT were similar. However, PMT required shorter hospital stay and less intensive surveillance, leading to lower total costs.
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Abstract
BACKGROUND About 5% to 10% of all deep vein thromboses occur in the upper extremities. Serious complications of upper extremity deep vein thrombosis, such as post-thrombotic syndrome and pulmonary embolism, may in theory be avoided using thrombolysis. No systematic review has assessed the effects of thrombolysis for the treatment of individuals with acute upper extremity deep vein thrombosis. OBJECTIVES To assess the beneficial and harmful effects of thrombolysis for the treatment of individuals with acute upper extremity deep vein thrombosis. SEARCH METHODS The Cochrane Vascular Information Specialist (CIS) searched the Specialised Register (29 March 2017), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 2), and three trial registries (World Health Organization International Clinical Trials Registry, ClinicalTrials.gov, and ISRCTN registry) for ongoing and unpublished studies. We additionally searched the registries of the European Medical Agency and the US Food and Drug Administration (December 2016). SELECTION CRITERIA We planned to include randomised clinical trials irrespective of publication type, publication date and language that investigated the effects of thrombolytics added to anticoagulation, thrombolysis versus anticoagulation, or thrombolysis versus any other type of medical intervention for the treatment of acute upper extremity deep vein thrombosis. DATA COLLECTION AND ANALYSIS Two review authors independently screened all records to identify those that met inclusion criteria. We planned to use the standard methodological procedures expected by Cochrane. We planned to use trial domains to assess the risks of systematic error (bias) in the trials. We planned to conduct trial sequential analyses to control for the risk of random errors and to assess the robustness of our conclusions. We planned to consider a P value of 0.025 or less as statistically significant. We planned to assess the quality of the evidence using the GRADE approach. Our primary outcomes were severe bleeding, pulmonary embolism, and all-cause mortality. MAIN RESULTS We found no trials eligible for inclusion. We also identified no ongoing trials. AUTHORS' CONCLUSIONS There is currently insufficient evidence from which to draw conclusion on the benefits or harms of thrombolysis for the treatment of individuals with acute upper extremity deep vein thrombosis as an add-on therapy to anticoagulation, alone compared with anticoagulation, or alone compared with any other type of medical intervention. Large randomised clinical trials with a low risk of bias are warranted. They should focus on clinical outcomes and not solely on surrogate measures.
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Affiliation(s)
- Joshua Feinberg
- Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812Blegdamsvej 9CopenhagenDenmark2100
- Glostrup University HospitalDepartment of MedicineValdemar Hansens Vej 1‐23GlostrupDenmark2600
| | - Emil Eik Nielsen
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenSjællandDenmarkDK‐2100
- Holbaek HospitalDepartment of CardiologyHolbaekDenmark4300
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Grant JD, Woller S, Lee E, Kee S, Liu D, Lohan D, Elliott CG, Stevens S. Diagnosis and management of upper extremity deep-vein thrombosis in adults. Thromb Haemost 2017; 108:1097-108. [DOI: 10.1160/th12-05-0352] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 08/30/2012] [Indexed: 11/05/2022]
Abstract
SummaryUpper extremity deep-vein thrombosis (UEDVT) is common and can cause important complications, including pulmonary embolism and post-thrombotic syndrome. An increase in the use of central venous catheters, particularly peripherally inserted central catheters has been associated with an increasing rate of disease. Accurate diagnosis is essential to guide management, but there are limitations to the available evidence for available diagnostic tests. Anticoagulation is the mainstay of therapy, but interventional treatments may be considered in select situations. The risk of UEDVT may be reduced by more careful selection of patients who receive central venous catheters and by use of smaller catheters. Herein we review the diagnosis, management and prevention of UEDVT. Due to paucity of research, some principles are drawn from studies of lower extremity DVT. We present a practical approach to diagnosing the patient with suspected deep-vein thrombosis of the upper extremity.
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Aye T, Phan TT, Muir DF, Linker NJ, Hartley R, Turley AJ. Novel experience of laser-assisted 'inside-out' central venous access in a patient with bilateral subclavian vein occlusion requiring pacemaker implantation. Europace 2017; 19:1750-1753. [PMID: 27742773 DOI: 10.1093/europace/euw239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 07/06/2016] [Indexed: 11/12/2022] Open
Abstract
Aim This new laser facilitated 'inside-out' technique was used for transvenous pacemaker insertion in a pacemaker-dependent patient with bilateral subclavian occlusion and a failed epicardial system who is not suitable for a transfemoral approach. Method and results Procedure was undertaken under general anaesthesia with venous access obtained from right femoral vein and left axillary vein. 7F multipurpose catheter was used to enter proximal edge of the occluded segment of subclavian vein via femoral approach, which then supported stiff angioplasty wires and microcatheters to tunnel into the body of occlusion. When encountered with impenetrable resistance, 1.4 mm Excimer laser helped delivery of a Pilot 200 wire, which then progressed towards the distal edge of occlusion. Serial balloon dilatations allowed wire tracked into subintimal plane, advanced towards left clavicle using knuckle wire technique, which was then externalized with blunt dissection from infraclavicular pocket area. It was later changed to Amplatz superstiff wire exiting from both ends to form a rail, which ultimately allowed passage of pacing leads after serial balloon dilatation from clavicular end. Conclusion Our hybrid 'inside-out' technique permitted transvenous pacemaker insertion without complication and this is, to our knowledge, the first case using laser in this context.
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Affiliation(s)
- Thandar Aye
- Department of Cardiology, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough TS4 3BW, UK
| | - Thanh Trung Phan
- Department of Cardiology, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough TS4 3BW, UK
| | - Douglas Findlay Muir
- Department of Cardiology, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough TS4 3BW, UK
| | - Nicholas John Linker
- Department of Cardiology, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough TS4 3BW, UK
| | - Richard Hartley
- Department of Radiology, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough TS4 3BW, UK
| | - Andrew John Turley
- Department of Cardiology, The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Marton Road, Middlesbrough TS4 3BW, UK
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Enoxaparin Dosing and the Prevention of Venous Thromboembolism in Plastic Surgery Patients. Plast Reconstr Surg 2017; 140:835e-836e. [PMID: 28820827 DOI: 10.1097/prs.0000000000003882] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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37
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Smeets MWJ, Mourik MJ, Niessen HWM, Hordijk PL. Stasis Promotes Erythrocyte Adhesion to von Willebrand Factor. Arterioscler Thromb Vasc Biol 2017; 37:1618-1627. [PMID: 28775074 DOI: 10.1161/atvbaha.117.309885] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/18/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Venous thromboembolism is a major contributor to global disease burden. Leukocytes and platelets initiate thrombogenesis on blood stasis and initiate the formation of a fibrin, VWF (von Willebrand factor), and neutrophil extracellular trap scaffold for erythrocytes. However, there is little knowledge on how erythrocytes become stably incorporated into this scaffold. Recently, we described the adhesion of calcium-loaded erythrocytes to endothelial-derived VWF strings. Because VWF is part of the scaffold of venous thrombi, we questioned whether reduced flow or stasis promotes the adhesion of normal erythrocytes to VWF and whether venous thrombi show evidence of erythrocyte-VWF interactions. APPROACH AND RESULTS In the present work, we perfused, under controlled shear conditions, washed, normal erythrocytes over surface-immobilized plasma and extracellular matrix proteins and showed that normal erythrocytes specifically bind to VWF. The interaction between erythrocytes and VWF significantly increased when the wall shear stress was reduced. Next, we investigated whether erythrocyte-VWF interactions support the structure of venous thrombi. High-resolution immunofluorescence imaging of human venous thrombi showed a striking pattern between erythrocytes, VWF, and fibrin, which suggests that VWF plays a supporting role, linking erythrocytes to fibrin in the thrombus. CONCLUSIONS Our data suggest that erythrocyte retention in venous thrombi is mediated by erythrocyte-VWF or erythrocyte-VWF-fibrin interactions. Targeting erythrocyte retention could be a new strategy in the treatment or prevention of venous thrombosis.
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Affiliation(s)
- Michel W J Smeets
- From the Departments of Molecular Cell Biology (M.W.J.S., P.L.H.) and Plasma Proteins (M.J.M.), Sanquin-Academic Medical Center Landsteiner Laboratory, Amsterdam, The Netherlands; and Department of Pathology and Cardiac Surgery, ICaR-VU (H.W.M.N.) and Department of Physiology (P.L.H.), VU University Medical Center, Amsterdam, The Netherlands.
| | - Marjon J Mourik
- From the Departments of Molecular Cell Biology (M.W.J.S., P.L.H.) and Plasma Proteins (M.J.M.), Sanquin-Academic Medical Center Landsteiner Laboratory, Amsterdam, The Netherlands; and Department of Pathology and Cardiac Surgery, ICaR-VU (H.W.M.N.) and Department of Physiology (P.L.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Hans W M Niessen
- From the Departments of Molecular Cell Biology (M.W.J.S., P.L.H.) and Plasma Proteins (M.J.M.), Sanquin-Academic Medical Center Landsteiner Laboratory, Amsterdam, The Netherlands; and Department of Pathology and Cardiac Surgery, ICaR-VU (H.W.M.N.) and Department of Physiology (P.L.H.), VU University Medical Center, Amsterdam, The Netherlands
| | - Peter L Hordijk
- From the Departments of Molecular Cell Biology (M.W.J.S., P.L.H.) and Plasma Proteins (M.J.M.), Sanquin-Academic Medical Center Landsteiner Laboratory, Amsterdam, The Netherlands; and Department of Pathology and Cardiac Surgery, ICaR-VU (H.W.M.N.) and Department of Physiology (P.L.H.), VU University Medical Center, Amsterdam, The Netherlands
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Kaczynski J, Sathiananthan J. Paget-Schroetter syndrome complicated by an incidental pulmonary embolism. BMJ Case Rep 2017; 2017:bcr-2017-219982. [PMID: 28768671 DOI: 10.1136/bcr-2017-219982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
A young man presented with the severe right upper limb swelling following a heavy weight lifting that was thought to be caused by a biceps tendon rupture. However, subsequent investigations confirmed the diagnosis of Paget-Schroetter syndrome that was associated with an incidental pulmonary embolism. The patient underwent a successful thrombolysis followed by a surgical thoracic outlet decompression. Overall, the patient has made a good recovery.
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Affiliation(s)
- Jakub Kaczynski
- Vascular Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, Dumfries and Galloway, UK
| | - Joseph Sathiananthan
- Vascular Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, Dumfries and Galloway, UK
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39
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Abdelaal Ahmed Mahmoud A, El-Shafei HI, Yassin HM, Elramely MA, Abdelhaq MM, El Kady HW, Awada WNF. Comparison Between Retrograde and Antegrade Peripheral Venous Cannulation in Intensive Care Unit Patients. Anesth Analg 2017; 124:1839-1845. [DOI: 10.1213/ane.0000000000001703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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40
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Adamčík M. A logician's approach to meta-analysis with unexplained heterogeneity. J Biomed Inform 2017; 71:110-129. [PMID: 28554831 DOI: 10.1016/j.jbi.2017.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/20/2017] [Accepted: 05/23/2017] [Indexed: 11/16/2022]
Abstract
Meta-analysis is a powerful tool for combining related studies but such an aggregation would be flawed if studies investigated different populations or applied different methods in this investigation. While studies with differences that are statistically detected but not explained can be analysed by techniques of random-effects meta-analysis, it is difficult to analyse a study if it provides us with complex knowledge. This paper introduces a new method for meta-analysis that deals with both complex knowledge and unexplained heterogeneity, and which shares some properties with Bayesian methods. The newly developed method is applicable in a wide range of medical and also non-medical problems. A demonstration will be provided on a real medical example concerning the one-year incidence of diagnosis of cancer in patients with unprovoked venous thromboembolism. Our main findings based on several recent statistically heterogeneous studies indicate significant improvement in the cancer detection rate if routine evaluation for those patients is performed jointly with extensive screening techniques.
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Affiliation(s)
- Martin Adamčík
- Martin de Tours School of Management and Economics, Assumption University, 10540 Samut Prakan, Thailand.
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41
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Heil J, Miesbach W, Vogl T, O. Bechstein W, Reinisch A. Deep Vein Thrombosis of the Upper Extremity. DEUTSCHES ARZTEBLATT INTERNATIONAL 2017; 114:244-249. [PMID: 28446351 PMCID: PMC5415909 DOI: 10.3238/arztebl.2017.0244] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 10/30/2016] [Accepted: 01/24/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Deep venous thrombosis (DVT) arises with an incidence of about 1 per 1000 persons per year; 4-10% of all DVTs are located in an upper extremity (DVT-UE). DVT-UE can lead to complications such as post-thrombotic syndrome and pulmonary embolism and carries a high mortality. METHODS This review is based on pertinent literature, published from January 1980 to May 2016, that was retrieved by a systematic search, employing the PRISMA criteria, carried out in four databases: PubMed (n = 749), EMBASE (n = 789), SciSearch (n = 0), and the Cochrane Library (n = 12). Guidelines were included in the search. RESULTS DVT-UE arises mainly in patients with severe underlying diseases, especially cancer (odds ratio [OR] 18.1; 95% confidence interval [9.4; 35.1]). The insertion of venous catheters-particularly central venous catheters-also elevates the risk of DVT-UE. Its clinical manifestations are nonspecific. Diagnostic algorithms are of little use, but ultrasonography is very helpful in diagnosis. DVT-UE is treated by anticoagulation, with heparin at first and then with oral anticoagulants. Direct oral anticoagulants are now being increasingly used. The thrombus is often not totally eradicated. Anticoagulation is generally continued as maintenance treatment for 3-6 months. Interventional techniques can be used for special indications. Patients with DVT-UE have a high mortality, though they often die of their underlying diseases rather than of the DVT-UE or its complications. CONCLUSION DVT of the upper extremity is becoming increasingly common, though still much less common than DVT of the lower extremity. The treatment of choice is anticoagulation, which is given analogously to that given for DVT of the lower extremity.
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Affiliation(s)
- Jan Heil
- Department of General and Visceral Surgery, University Hospital Frankfurt, Frankfurt am Main
| | - Wolfgang Miesbach
- Hemostasiology, Department of Medicine II, University Hospital Frankfurt, Frankfurt am Main
| | - Thomas Vogl
- Institute of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt am Main
| | - Wolf O. Bechstein
- Department of General and Visceral Surgery, University Hospital Frankfurt, Frankfurt am Main
| | - Alexander Reinisch
- Department of General and Visceral Surgery, University Hospital Frankfurt, Frankfurt am Main
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Vazquez FJ, Paulin P, Poodts D, Gándara E. Preferred Management of Primary Deep Arm Vein Thrombosis. Eur J Vasc Endovasc Surg 2017; 53:744-751. [PMID: 28342731 DOI: 10.1016/j.ejvs.2016.11.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 11/14/2016] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Given its rarity, the management of primary upper extremity deep vein thrombosis is controversial. Although anticoagulation alone is commonly advocated for its treatment, it is unclear if this will reduce the risk of developing post-thrombotic syndrome (PTS). The aim of this "Evidence Driven" Clinical Scenario is to evaluate whether more aggressive treatments (including catheter directed thrombolysis or surgery) might help reduce the risk of PTS or recurrent venous thromboembolism in patients with primary upper extremity deep vein thrombosis (DVT). METHODS An electronic systematic review of Ovid MEDLINE and Embase was conducted. Randomised controlled trials and observational studies were eligible. The primary outcome was PTS. RESULTS The initial search identified 146 articles, and 36 more were identified during a secondary search. In total, 25 studies, reporting the outcome of 1271 patients, were included. None of the studies included was a randomised controlled trial and the large majority of studies were retrospective cohorts. The use of anticoagulation alone was associated with a significant risk of PTS. In patients treated with surgery with or without thrombolysis the incidence of PTS was significantly reduced. CONCLUSION Current evidence, albeit with some methodological limitations, suggests that anticoagulation may not be sufficient to prevent PTS in patients with primary upper extremity DVT and that surgery with or without thrombolysis to repair the anatomical defects is needed.
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Affiliation(s)
- F J Vazquez
- Department of Internal Medicine, Hospital Italiano de Buenos Aires, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - P Paulin
- Department of Internal Medicine, Hospital Italiano de Buenos Aires, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - D Poodts
- Department of Internal Medicine, Hospital Italiano de Buenos Aires, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - E Gándara
- Department of Medicine, University of Ottawa-Ottawa Hospital, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada; Department of Internal Medicine, Hospital Privado de Comunidad, Mar del Plata, Argentina.
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Kho SS, Tie ST, Chan SK, Yong MC, Chai SL, Voon PJ. Chylothorax and central vein thrombosis, an under-recognized association: a case series. Respirol Case Rep 2017; 5:e00221. [PMID: 28250931 PMCID: PMC5325873 DOI: 10.1002/rcr2.221] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/14/2017] [Accepted: 01/24/2017] [Indexed: 01/31/2023] Open
Abstract
Chylothorax is defined as the presence of chyle in the pleural cavity. Central vein thrombosis is an under‐recognized cause of chylothorax in the adult population and is commonly related to central venous catheterization. Case 1 illustrates a patient with AIDS and disseminated tuberculosis with left chylothorax and central vein thrombosis after a month of antituberculosis therapy. Case 2 was a patient with advanced seminoma who presented with left chylothorax and central vein thrombosis while on chemotherapy. Chylothorax resolved with anticoagulation for both cases. Case 3 was a lymphoma patient with central vein thrombosis who developed chylothorax during chemotherapy. Chylothorax resolved with the continuation of anticoagulation and did not recur despite his progressive underlying lymphoma. There was no central venous catheterization in any of these three cases. These cases illustrate the unique association of central vein thrombosis and chylothorax and the importance of anticoagulation in its management.
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Affiliation(s)
- Sze Shyang Kho
- Respiratory Medicine Unit, Department of Medicine Sarawak General Hospital Kuching Malaysia
| | - Siew Teck Tie
- Respiratory Medicine Unit, Department of Medicine Sarawak General Hospital Kuching Malaysia
| | - Swee Kim Chan
- Respiratory Medicine Unit, Department of Medicine Sarawak General Hospital Kuching Malaysia
| | - Mei Ching Yong
- Respiratory Medicine Unit, Department of Medicine Sarawak General Hospital Kuching Malaysia
| | - Sing Ling Chai
- Department of Diagnostic Imaging Sarawak General Hospital Kuching Malaysia
| | - Pei Jye Voon
- Department of Radiotherapy and Oncology Unit Sarawak General Hospital Kuching Malaysia
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44
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What is causing this man's facial flushing? JAAPA 2017; 30:55-57. [DOI: 10.1097/01.jaa.0000511801.98996.ff] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Abstract
We reported a case of a former water polo player who suffered from a non-traumatic right subclavian vein thrombosis. An otherwise healthy former athlete developed thrombosis of the right subclavian vein. He presented with swelling of his right arm. Diagnosis was made by colour doppler ultrasonography. He received low molecular weight heparin as initial treatment followed by thrombolytic therapy with alteplase and heparin infusion. He continued with outpatient anticoagulant therapy for six months before returning to usual daily activities. There is no evidence or report on the time length after ending of an athletic pursuit that would predispose to the formation of subclavian vein thrombosis. Early diagnosis and treatment of patients with subclavian vein thrombosis is important in order to avoid complications, occupational disability and the adverse impact on the patient's quality of life.
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Affiliation(s)
- M Sorić
- University Hospital Dubrava, Department of Emergency Medicine, Gojko Šušak Avenue 6 Zagreb, Croatia
| | - V Grabovac
- University Hospital Dubrava, Department of Emergency Medicine, Gojko Šušak Avenue 6 Zagreb, Croatia
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46
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Sanson H, Gautier V, Stansal A, Sfeir D, Franceschi C, Priollet P. [Deep venous thrombosis of the upper limb in a violin player: The "bow syndrome"]. ACTA ACUST UNITED AC 2016; 41:396-402. [PMID: 27823916 DOI: 10.1016/j.jmv.2016.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Exercise-induced thrombosis is a rare cause of deep venous thrombosis (DVT) of the upper limb and usually affects young subjects without comorbid conditions. The diagnosis may be challenging. CASE REPORT A 23-year-old female right-handed French teacher and amateur violin player presented with edema of the root of the right arm associated with erythrocyanosis of the extremity and collateral circulation of the shoulder. History taking revealed oral contraception and recent change in violin playing habits. D-dimers were negative. A second duplex-Doppler was required before visualization of a DVT in the right subclavian vein. The patient was given low-molecular-weight heparin alone, followed by rivaroxaban. The outcome was very favorable at 48h. The patient was seen at 4 months and had not had a recurrent episode. DISCUSSION The diagnosis of DVT of the upper limb is basically clinical. There is a clinical probability score for the introduction of anticoagulation even if the duplex-Doppler fails to visualize DVT, a situation that can occur due to the clavicular superposition in this region. Exercise-induced DVT should be suspected in patients with minimally intense but repeated exercise (hyper-abduction), e.g. as here playing the violin. Anticoagulation is the treatment of choice. The role for surgery and pharmacomechanical strategies remains to be defined. CONCLUSION Exercise-induced thrombosis (Paget-Schroetter syndrome) should be suspected in young patients free of any comorbidity who develop a thrombosis of the upper limb. Studies comparing different therapeutic options would be useful to achieve more homogeneous management practices despite the heterogeneous clinical presentations.
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Affiliation(s)
- H Sanson
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
| | - V Gautier
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - A Stansal
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - D Sfeir
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - C Franceschi
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - P Priollet
- Service de médecine vasculaire, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
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47
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Upper Extremity Deep Vein Thromboses: The Bowler and the Barista. Case Rep Vasc Med 2016; 2016:9631432. [PMID: 27800207 PMCID: PMC5075304 DOI: 10.1155/2016/9631432] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 09/02/2016] [Accepted: 09/18/2016] [Indexed: 11/17/2022] Open
Abstract
Effort thrombosis of the upper extremity refers to a deep venous thrombosis of the upper extremity resulting from repetitive activity of the upper limb. Most cases of effort thrombosis occur in young elite athletes with strenuous upper extremity activity. This article reports two cases who both developed upper extremity deep vein thromboses, the first being a 67-year-old bowler and the second a 25-year-old barista, and illustrates that effort thrombosis should be included in the differential diagnosis in any patient with symptoms concerning DVT associated with repetitive activity. A literature review explores the recommended therapies for upper extremity deep vein thromboses.
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48
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Min SK, Park YH, Cho YK, Park JW, Koh YH, Seo TS. Lemierre’s Syndrome: Unusual Cause of Internal Jugular Vein Thrombosis. Angiology 2016; 56:483-7. [PMID: 16079933 DOI: 10.1177/000331970505600417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lemierre’s syndrome is an uncommon septic thrombophlebitis of the internal jugular vein. The authors present the case of a 52-year-old woman with literature review. She developed flu-like symptoms and fever, and then painful swelling of the left side of her neck and left arm. Contrast-enhanced computed tomography of the neck revealed thrombosis in the left internal jugular vein, subclavian vein, and brachiocephalic vein and diffuse soft tissue inflammation around the veins. No microorganism was identified in the blood and venous thrombus, which was obtained by percutaneous aspiration thrombectomy. Systemic antibiotics and anticoagulation therapy achieved complete resolution of the symptoms. Recanalization of the thrombosed veins with no residual thrombi was observed on duplex scanning after 3 months. No pulmonary embolism or other metastatic infection was observed. Clinical suspicion seems to be essential to make an accurate diagnosis during the early stage of the disease, which is critical to obtain a successful outcome for Lemierre’s syndrome.
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Affiliation(s)
- Seung Kee Min
- Department of Surgery, Gachon Medical School Gil Medical Center, Incheon, South Korea.
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49
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Schoot RA, van de Wetering MD, Stijnen T, Tissing WJE, Michiels E, Abbink FCH, Raphael MF, Heij HA, Zwaan M, Lieverst JA, Caron HN, van Ommen H. Prevalence of Symptomatic and Asymptomatic Thrombosis in Pediatric Oncology Patients With Tunneled Central Venous Catheters. Pediatr Blood Cancer 2016; 63:1438-44. [PMID: 27128820 DOI: 10.1002/pbc.26036] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 04/01/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Pediatric oncology patients with tunneled central venous catheters (CVCs) are at increased risk to develop venous thromboembolic events (VTEs), but the true prevalence of (a)symptomatic VTE is unknown. Aim of this study was to evaluate the prevalence of (a)symptomatic VTE in pediatric oncology patients with tunneled CVCs. PROCEDURE All patients were included in the Aristocaths study: a randomized controlled multicenter trial investigating the prophylactic effect of 70% ethanol locks on CVC-associated bloodstream infections (CABSIs) were eligible for this study. We assessed the following outcomes: (i) symptomatic VTE and (ii) asymptomatic CVC-related VTE (using ultrasound [US]). Follow-up was 6 months, unless patients developed one of the following events: VTE, CABSI, CVC removal, or death. RESULTS We included 305 patients (hematologic malignancy, n = 148; solid tumor, n = 157), median age 9 years (range, 1-18 years). Symptomatic VTE was detected in 8 of 305 patients (2.6%; 95% confidence interval [CI]: 1.1-5.1%), which was related to the CVC in three patients. Patients (185/305) were evaluated with US: 11 of 185 (5.9%; 95% CI: 3.0-10.4%) patients had asymptomatic CVC-related VTE. CONCLUSIONS Prevalence of both symptomatic VTE and asymptomatic CVC-related VTE was low compared to other studies, which may be explained by the inclusion of patients with solid tumors, reduction of CABSI by ethanol, use of tunneled CVCs, and use of US.
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Affiliation(s)
- Reineke A Schoot
- Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Marianne D van de Wetering
- Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Theo Stijnen
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
| | - Wim J E Tissing
- Department of Pediatric Oncology, Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands
| | - Erna Michiels
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Floor C H Abbink
- Department of Pediatric Oncology/Hematology, VU University Medical Center, Amsterdam, The Netherlands
| | - Martine F Raphael
- Department of Pediatric Oncology/Hematology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Hugo A Heij
- Pediatric Surgical Center Amsterdam, Academic Medical Center & VU University Medical Center, Amsterdam, The Netherlands
| | - Michel Zwaan
- Department of Pediatric Oncology/Hematology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jan A Lieverst
- Dutch Childhood Oncology Group, The Hague, The Netherlands
| | - Hubert N Caron
- Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - Heleen van Ommen
- Department of Pediatric Hematology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
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50
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Paget-Schroetter syndrome after a dental procedure in a patient with factor V Leiden (R506Q) heterozygosity. Blood Coagul Fibrinolysis 2016; 28:269-271. [PMID: 27428017 DOI: 10.1097/mbc.0000000000000592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: Paget-Schroetter syndrome or effort thrombosis is characterized by spontaneous thrombosis of the upper extremity venous system, commonly seen in a young healthy patient after repetitive use of the upper extremities. It is rarely associated with coagulopathy and thus, hypercoagulable work-up is not usually a part of the investigation. We present a first case of a young woman, who was diagnosed with left upper extremity effort thrombosis following a dental procedure. Interestingly, she was also noted to be heterozygous for factor V Leiden mutation.
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