Hingorani A, Ascher E, Ward M, Mazzariol F, Gunduz Y, Ramsey P J, Yorkovich W
Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA.
Cardiovasc Surg. 2001 Oct;9(5):472-7. doi: 10.1016/s0967-2109(01)00039-4.
In order to elucidate the natural history of upper extremity deep venous thrombosis (UEDVT), we compared the morbidity and mortality of patients with UEDVT and that of patients with both UEDVT and lower extremity deep venous thrombosis (LEDVT). Between 1993 and 1996, 21 patients presented to our institution with both LEDVT and UEDVT (Group 1). During the same time period, 144 patients were diagnosed with UEDVT alone (Group 2). The diagnosis was confirmed by duplex scanning in all patients. In Group 1, there were 14 females (67%) and 7 males (23%) with ages ranging from 25 to 97 yr old [mean 73 yr old +/-17 yr (SD)]. In Group 2, there were 84 females (58%) and 60 males (42%) with ages ranging from 9 to 101 yr old [mean 67 yr old +/-17 yr (SD)]. Differences in age and sex between the two groups were not statistically significant. In Group 1, systemic anticoagulation was implemented in 17 patients (81%). Two patients (9.5%) required placement of a SVC and IVC filters due to contraindication to anticoagulation. One patient did not receive anticoagulation, and one patient was only started on aspirin. In Group 2, treatment consisted of systemic anticoagulation in 94 patients (65%). The remainder of the patients were treated with aspirin in three patients (2%) or no anticoagulation in 31 patients (19%). Sixteen patients (11%) underwent placement of a SVC filter either due to failure of anticoagulation to prevent pulmonary embolism (two patients) or contraindication to anticoagulation (14 patients). Pulmonary emboli were documented by ventilation/perfusion lung scan in two patients (9.5%) in Group 1 and in 16 patients (11%) in Group 2. In the first group, 8 of the 21 patients (38%) were dead within 1 month of the diagnosis of UEDVT, and 11 of 21 patients (52%) were dead within 2 months of the diagnosis of UEDVT. In the second group, 20 of 144 patients (14%) were dead within 1 month of the diagnosis of UEDVT and 38 of 144 patients (26%) were dead within 2 months of diagnosis (P<0.02). Our data suggest that patients with both UEDVT and LEDVT have a higher mortality than patients with UEDVT alone. As the risk for pulmonary embolism is similar in both groups, we speculate that the severity of medical illness in patients with both UEDVT and LEDVT may contribute to the higher mortality. This is the first study to examine the mortality of this group of patients.
为了阐明上肢深静脉血栓形成（UEDVT）的自然病史，我们比较了UEDVT患者以及同时患有UEDVT和下肢深静脉血栓形成（LEDVT）患者的发病率和死亡率。1993年至1996年期间，21例患者因同时患有LEDVT和UEDVT前来我院就诊（第1组）。在同一时期，144例患者被诊断为单纯UEDVT（第2组）。所有患者均通过双功扫描确诊。第1组中有14名女性（67%）和7名男性（23%），年龄范围为25至97岁[平均73岁±17岁（标准差）]。第2组中有84名女性（58%）和60名男性（42%），年龄范围为9至101岁[平均67岁±17岁（标准差）]。两组之间的年龄和性别差异无统计学意义。第1组中，17例患者（81%）接受了全身抗凝治疗。2例患者（9.5%）因抗凝禁忌证需要放置上腔静脉（SVC）和下腔静脉（IVC）滤器。1例患者未接受抗凝治疗，1例患者仅开始服用阿司匹林。第2组中，94例患者（65%）接受了全身抗凝治疗。其余患者中，3例患者（2%）接受了阿司匹林治疗，31例患者（19%）未接受抗凝治疗。16例患者（11%）因抗凝治疗未能预防肺栓塞（2例患者）或抗凝禁忌证（14例患者）而接受了SVC滤器置入术。第1组中有2例患者（9.5%）通过通气/灌注肺扫描证实发生了肺栓塞，第2组中有16例患者（11%）发生了肺栓塞。在第一组中，21例患者中有8例（38%）在UEDVT诊断后1个月内死亡，21例患者中有11例（52%）在UEDVT诊断后2个月内死亡。在第二组中，144例患者中有20例（14%）在UEDVT诊断后1个月内死亡，144例患者中有38例（26%）在诊断后2个月内死亡（P<0.02）。我们的数据表明，同时患有UEDVT和LEDVT的患者的死亡率高于单纯UEDVT患者。由于两组发生肺栓塞的风险相似，我们推测同时患有UEDVT和LEDVT的患者的内科疾病严重程度可能导致了更高的死亡率。这是第一项研究该组患者死亡率的研究。
