Becker D M, Philbrick J T, Walker F B
Department of Medicine, University of Virginia Health Sciences Center, Charlottesville 22908.
Arch Intern Med. 1991 Oct;151(10):1934-43.
To clarify the prognosis of axillary and subclavian deep venous thrombosis and to determine which clinical factors influence its sequelae, we systematically reviewed the English-language literature published on this subject since 1950. Seventy-one case reports and 17 case series describing a total of 329 patients met our inclusion criteria for detailed review. There were major deficiencies in the quality, as well as quantity, of the available clinical data: few patients were enrolled at axillary and subclavian deep venous thrombosis inception, and outcome assessments were susceptible to bias and based on insensitive diagnostic tests. Posttreatment symptoms were reported in 34% of cases, pulmonary embolism in 9.4% (one half documented by lung scan or angiography), and death in 1.2% (three of four deaths due to pulmonary emboli). These complications occurred regardless of etiologic category (spontaneous, catheter related, or miscellaneous). Thrombolytic agents and surgery, in addition to anticoagulation, were often used to treat axillary and subclavian deep venous thrombosis, but there were no controlled trials to support any one approach. Until such trials are performed, therapy should be based on the anticoagulation regimens proved to be effective for deep venous thrombosis of the lower extremity. In selected patients, thrombolytic therapy and surgery may have important roles.
为明确腋静脉及锁骨下深静脉血栓形成的预后，并确定哪些临床因素会影响其后遗症，我们系统回顾了自1950年以来发表的关于该主题的英文文献。71篇病例报告和17篇病例系列共描述了329例患者，符合我们详细回顾的纳入标准。现有临床资料在质量和数量上均存在重大缺陷：很少有患者在腋静脉及锁骨下深静脉血栓形成初期入组，结局评估易产生偏倚且基于不敏感的诊断试验。34%的病例报告了治疗后症状，9.4%发生肺栓塞（其中一半经肺部扫描或血管造影证实），1.2%死亡（4例死亡中有3例死于肺栓塞）。这些并发症的发生与病因类别（自发性、导管相关性或其他）无关。除抗凝治疗外，溶栓药物和手术也常被用于治疗腋静脉及锁骨下深静脉血栓形成，但尚无对照试验支持任何一种治疗方法。在进行此类试验之前，治疗应基于已被证明对下肢深静脉血栓形成有效的抗凝方案。在特定患者中，溶栓治疗和手术可能发挥重要作用。
