Upper-extremity Deep Vein Thrombosis

Authors: Mrugeshkumar K. Shah MD, MPh, MS, David T. Burke MD, MA, Stephanie H. Shah MD


Upper-extremity deep vein thrombosis (UEDVT) was an understudied disease until recently. Previously thought of as benign, UEDVT has been shown in recent studies to pose a significant risk for pulmonary embolus and death. This article reviews the epidemiology, risk factors, clinical features, diagnostic tests, treatment options, complications, and prevention strategies for patients with UEDVT.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Horattas MC, Wright DJ, Fenton AH, Evans DM, Oddi MA, Kamienski RW, et al. Changing concepts of deep venous thrombosis of the upper extremity: Report of a series and review of the literature. Surgery 1988; 104: 561–567.
2. Paget J. Clinical Lectures and Essays. London, Longmans, Green, and Co., 1875.
3. Von Schroetter L. Nothnagel Handbuch der Pathologie und Therapie. Vienna, Holder, 1884.
4. Burihan E, de Figueiredo LF, Francisco J Jr, Miranda F Jr. Upper-extremity deep venous thrombosis: Analysis of 52 cases. Cardiovasc Surg 1993; 1: 19–22.
5. Hingorani A, Ascher E, Yorkovich W, Mazzariol F, Jacob T, Gunduz Y, et al. Upper extremity deep venous thrombosis: An underrecognized manifestation of a hypercoagulable state. Ann Vasc Surg 2000; 14: 421–426.
6. Prandoni P, Polistena P, Bernardi E, Cogo A, Casara D, Verlato F, et al. Upper-extremity deep vein thrombosis: Risk factors, diagnosis, and complications. Arch Intern Med 1997; 157: 57–62.
7. Hughes ESR. Venous obstruction in the upper extremity. Br J Surg 1949; 36: 155–163.
8. Prandoni P, Bernardi E. Upper extremity deep vein thrombosis. Curr Opin Pulm Med 1999; 5: 222–226.
9. Carman TL, Fernandez BB Jr. Issues and controversies in venous thromboembolism. Cleve Clin J Med 1999; 66: 113–123.
10. Marinella MA, Kathula SK, Markert RJ. Spectrum of upper-extremity deep venous thrombosis in a community teaching hospital. Heart Lung 2000; 29: 113–117.
11. Welch GW, McKeel DW Jr, Silverstein P, Walker HL. The role of catheter composition in the development of thrombophlebitis. Surg Gynecol Obstet 1974; 138: 421–424.
12. McDonough JJ, Altemeier WA. Subclavian venous thrombosis secondary to indwelling catheters. Surg Gynecol Obstet 1971; 133: 397–400.
13. Ross AH, Griffith CD, Anderson JR, Grieve DC. Thromboembolic complications with silicone elastomer subclavian catheters. JPEN J Parenter Enteral Nutr 1982; 6: 61–63.
14. Martin C, Viviand X, Saux P, Gouin F. Upper-extremity deep vein thrombosis after central venous catheterization via the axillary vein. Crit Care Med 1999; 27: 2626–2629.
15. Heron E, Lozinguez O, Alhenc-Gelas M, Emmerich J, Fiessinger JN. Hypercoagulable states in primary upper-extremity deep vein thrombosis. Arch Intern Med 2000; 160: 382–386.
16. Ellis MH, Manor Y, Witz M. Risk factors and management of patients with upper limb deep vein thrombosis. Chest 2000; 117: 43–46.
17. Lindblad B, Tengborn L, Bergqvist D. Deep vein thrombosis of the axillary-subclavian veins: Epidemiologic data, effects of different types of treatment and late sequelae. Eur J Vasc Surg 1988; 2: 161–165.
18. Hingorani A, Ascher E, Hanson J, Scheinman M, Yorkovich W, Lorenson E, et al. Upper extremity versus lower extremity deep venous thrombosis. Am J Surg 1997; 174: 214–217.
19. Kooij JD, van der Zant FM, van Beek EJ, Reekers JA. Pulmonary embolism in deep venous thrombosis of the upper extremity: More often in catheter-related thrombosis. Neth J Med 1997; 50: 238–242.
20. Painter TD, Karpf M. Deep venous thrombosis of the upper extremity: Five years experience at a university hospital. Angiology 1984; 35: 743–749.
21. Hicken GJ, Ameli FM. Management of subclavian-axillary vein thrombosis: A review. Can J Surg 1998; 41: 13–25.
22. Stone LR, Keenan MA. Deep-venous thrombosis of the upper extremity after traumatic brain injury. Arch Phys Med Rehabil 1992; 73: 486–489.
23. Kissel DJ. Pulmonary embolism from axillosubclavian thrombosis on a rehabilitation unit: Case report. Arch Phys Med Rehabil 1997; 78: 319–323.
24. Robinson KS, Anderson DR, Gross M, Petrie D, Leighton R, Stanish W, et al. Accuracy of screening compression ultrasonography and clinical examination for the diagnosis of deep vein thrombosis after total hip or knee arthroplasty. Can J Surg 1998; 41: 368–373.
25. Campbell CB, Chandler JG, Tegtmeyer CJ, Bernstein EF. Axillary, subclavian, and brachiocephalic vein obstruction. Surgery 1977; 82: 816–826.
26. Sottiurai VS, Towner K, McDonnell AE, Zarins CK. Diagnosis of upper extremity deep venous thrombosis using noninvasive technique. Surgery 1982; 91: 582–585.
27. Patwardhan NA, Anderson FA Jr, Cutler BS, Wheeler HB. Noninvasive detection of axillary and subclavian venous thrombosis by impedance plethysmography. J Cardiovasc Surg (Torino) 1983; 24: 250–255.
28. Zufferey P, Pararas C, Monti M, Depairon M. Assessment of acute and old deep venous thrombosis in upper extremity by venous strain gauge plethysmography. Vasa 1992; 21: 263–267.
29. Haire WD, Lynch TG, Lund GB, Lieberman RP, Edney JA. Limitations of magnetic resonance imaging and ultrasound-directed (duplex) scanning in the diagnosis of subclavian vein thrombosis. J Vasc Surg 1991; 13: 391–397.
30. Pollak EW, Walsh J. Subclavian-axillary venous thrombosis: Role of noninvasive diagnostic methods. South Med J 1980; 73: 1503–1506.
31. Swinton NW Jr, Edgett JW Jr, Hall RJ. Primary subclavian-axillary vein thrombosis. Circulation 1968; 38: 737–745.
32. Druy EM, Trout HH III, Giordano JM, Hix WR. Lytic therapy in the treatment of axillary and subclavian vein thrombosis. J Vasc Surg 1985; 2: 821–827.
33. O'Leary MR, Smith MS, Druy EM. Diagnostic and therapeutic approach to axillary-subclavian vein thrombosis. Ann Emerg Med 1987; 16: 889–893.
34. Savage KJ, Wells PS, Schulz V, Goudie D, Morrow B, Cruickshank M, et al. Outpatient use of low molecular weight heparin (Dalteparin) for the treatment of deep vein thrombosis of the upper extremity. Thromb Haemost 1999; 82: 1008–1010.
35. Ameli FM, Minas T, Weiss M, Provan JL. Consequences of “conservative” conventional management of axillary vein thrombosis. Can J Surg 1987; 30: 167–169.
36. Ascher E, Hingorani A, Mazzariol F, Jacob T, Yorkovich W, Gade P. Clinical experience with superior vena caval Greenfield filters. J Endovasc Surg 1999; 6: 365–369.
37. Ascher E, Hingorani A, Tsemekhin B, Yorkovich W, Gunduz Y. Lessons learned from a 6-year clinical experience with superior vena cava Greenfield filters. J Vasc Surg 2000; 32: 881–887.
38. Burke DT. Prevention of deep venous thrombosis: Overview of available therapy options for rehabilitation patients. Am J Phys Med Rehabil 2000; 79( 5 Suppl): S3–S8.
39. Monreal M, Alastrue A, Rull M, Mira X, Muxart J, Rosell R, et al. Upper extremity deep venous thrombosis in cancer patients with venous access devices: Prophylaxis with a low molecular weight heparin (Fragmin). Thromb Haemost 1996; 75: 251–253.