Ascher Enrico, Salles-Cunha Sergio, Hingorani Anil
Maimonides Medical Center, Brooklyn, NY 11219, USA.
Vasc Endovascular Surg. 2005 Jul-Aug;39(4):335-9. doi: 10.1177/153857440503900405.
The authors have noted a significant incidence of pulmonary embolism and mortality associated with upper extremity deep venous thrombosis (UEDVT). Since there is an association between the site of lower extremity DVT (LEDVT) and pulmonary embolism, they hypothesized that there might also be a correlation between the site of UEDVT and the incidence of pulmonary embolism (PE) and associated mortality. To further elucidate this hypothesis, they analyzed the mortality rate and incidence of PE diagnosed with subclavian/axillary or internal jugular vein thrombosis during a 5-year period at their institution. Two hundred and ten patients were diagnosed with acute internal jugular and/or subclavian/axillary DVT during a 5-year period by duplex scanning. The indications for the duplex examination were upper extremity swelling in 187 (89%) or as part of the work-up for pulmonary embolism in 23 (11%). There were 126 women (60%) and 84, men (40%). The mean age was 67 +/-18 years (range 1-101 years). The patients were divided into 3 groups based on the location of the thrombus: Group I-UEDVT involving the subclavian and/or axillary veins (n = 128); Group II-internal jugular vein thrombosis alone (n = 21); and Group III-concomitant subclavian/axillary and internal jugular vein DVT (n = 61). Risk factors were presence of central venous catheter or pacemaker in 127 patients (60%), malignancy in 78 patients (37%), concomitant lower extremity deep venous thrombosis (LEDVT) in 40 patients (19%), and history of LEDVT in 6 patients (3%). Eighty (38%) patients had more than 1 risk factor. The mean follow-up period was 13 +/-1 months (range 0-49 months). Mortality rates at 1, 3, and 12 months were 13%, 31%, and 40% for Group I; 14%, 33%, and 42% for Group II; and 23%, 44%, and 59% for Group III. The mortality rate in Group I was statistically significantly higher for patients >/=75 years old, patients not treated with anticoagulation, and patients who underwent placement of a central venous line. The same risk factors did not achieve statistical significance in the 2 other groups. The number of patients diagnosed with pulmonary embolism by ventilation/perfusion scans in Groups I, II, and III that could be attributed to the UEDVT solely was 8 (4%), 1 (0.5%), and 3 (2.4%), respectively. Contrary to the initial hypothesis of a relationship between the site of thrombosis and the incidence of pulmonary embolism and mortality, these data showed no statistical differences in mortality rate or incidence of pulmonary embolism among the 3 groups studied. These data also suggest that internal jugular vein thrombosis is a disease process associated with mortality and morbidity rates comparable to those of subclavian/axillary vein thrombosis.
作者们注意到上肢深静脉血栓形成（UEDVT）相关的肺栓塞和死亡率有显著发生率。由于下肢深静脉血栓形成（LEDVT）的部位与肺栓塞之间存在关联，他们推测UEDVT的部位与肺栓塞（PE）的发生率及相关死亡率之间可能也存在相关性。为了进一步阐明这一假设，他们分析了在其机构5年期间诊断为锁骨下/腋静脉或颈内静脉血栓形成的患者的死亡率和PE发生率。在5年期间，通过双功扫描诊断出210例急性颈内和/或锁骨下/腋静脉DVT患者。双功检查的指征为187例（89%）上肢肿胀或23例（11%）作为肺栓塞检查的一部分。有126名女性（60%）和84名男性（40%）。平均年龄为67±18岁（范围1 - 101岁）。根据血栓部位将患者分为3组：第一组 - UEDVT累及锁骨下和/或腋静脉（n = 128）；第二组 - 单独的颈内静脉血栓形成（n = 21）；第三组 - 锁骨下/腋静脉和颈内静脉DVT并存（n = 61）。危险因素包括127例患者（60%）存在中心静脉导管或起搏器，78例患者（37%）患有恶性肿瘤，40例患者（19%）合并下肢深静脉血栓形成（LEDVT），6例患者（3%）有LEDVT病史。80例（38%）患者有不止1个危险因素。平均随访期为13±1个月（范围0 - 49个月）。第一组1个月、3个月和12个月的死亡率分别为13%、31%和40%；第二组分别为14%、33%和42%；第三组分别为23%、44%和59%。对于年龄≥75岁、未接受抗凝治疗以及接受中心静脉置管的第一组患者，死亡率在统计学上显著更高。相同的危险因素在其他两组中未达到统计学显著性。第一组、第二组和第三组中仅归因于UEDVT通过通气/灌注扫描诊断为肺栓塞的患者数量分别为8例（4%）、1例（0.5%）和3例（2.4%）。与血栓形成部位与肺栓塞发生率及死亡率之间关系的最初假设相反，这些数据显示在研究的3组之间死亡率或肺栓塞发生率没有统计学差异。这些数据还表明颈内静脉血栓形成是一种与死亡率和发病率相关的疾病过程，与锁骨下/腋静脉血栓形成相当。
