Klitfod L, Broholm R, Baekgaard N
Vascular Clinic, Gentofte and Rigshospitalet, University of Copenhagen, 2900 Hellerup, Denmark.
Int Angiol. 2013 Oct;32(5):447-52.
Upper extremity deep venous thrombosis (UEDVT) occurs either spontaneously, as a consequence of strenuous upper limb activity (also known as the Paget-Schroetter syndrome) or secondary to an underlying cause. Primary and secondary UEDVT differs in long-term sequelae and mortality. This review will focus on the clinical presentation, risk factors, diagnosis, and treatment strategies of UEDVT. In the period from January to October 2012 an electronic literature search was performed in the PubMed/MEDLINE database, and 27 publications were included.
swelling, pain and functional impairment are typical symptoms of UEDVT, although completely asymptomatic cases have been described. However life-threatening, massive pulmonary embolism (PE) can also be a sign of UEDVT.
for the primary condition anatomical abnormalities (Thoracic Outlet Syndrome, TOS) may dispose to the condition. Malignancy and therapeutic interventions are major risk factors for the secondary deep vein thrombosis in combination with the patient's characteristics, comorbidities and prior history of deep vein thrombosis.
recurrent deep venous thrombosis, pulmonary embolism and Post Thrombotic Syndrome (PTS) are the major complications after UEDVT. PTS is a chronic condition leading to significant functional disability and impaired quality of life.
compression ultrasonography is noninvasive and the most frequently used objective test with a high accuracy in experienced hands. Treatment modalities and strategies: the treatment modalities include anticoagulation therapy, catheter-directed thrombolysis, surgical decompression, percutaneous transluminal angioplasty and stenting and they may be combined. However, the optimal treatment and timing of treatment remains controversial. Early diagnosis and treatment is essential to prevent PTS in primary UEDVT; however, there is no consensus on which treatment is the best. Anticoagulation is still considered the treatment of choice for at least 3-6 months, until Randomized Controlled Trials may have demonstrated otherwise.
上肢深静脉血栓形成（UEDVT）可自发发生，或是剧烈上肢活动的结果（也称为Paget-Schroetter综合征），或是继发于潜在病因。原发性和继发性UEDVT在长期后遗症和死亡率方面有所不同。本综述将聚焦于UEDVT的临床表现、危险因素、诊断及治疗策略。在2012年1月至10月期间，在PubMed/MEDLINE数据库中进行了电子文献检索，共纳入27篇出版物。
肿胀、疼痛和功能障碍是UEDVT的典型症状，不过也有完全无症状病例的报道。然而，危及生命的大面积肺栓塞（PE）也可能是UEDVT的一个迹象。
对于原发性疾病，解剖学异常（胸廓出口综合征，TOS）可能易引发该病。恶性肿瘤和治疗性干预措施与患者的特征、合并症及既往深静脉血栓形成病史相结合，是继发性深静脉血栓形成的主要危险因素。
复发性深静脉血栓形成、肺栓塞和血栓后综合征（PTS）是UEDVT后的主要并发症。PTS是一种慢性疾病，会导致严重的功能残疾和生活质量受损。
压迫超声检查是非侵入性的，是经验丰富的医生最常使用的客观检查方法，准确性很高。治疗方式和策略：治疗方式包括抗凝治疗、导管定向溶栓、手术减压、经皮腔内血管成形术和支架置入术，这些方法可联合使用。然而，最佳治疗方法和治疗时机仍存在争议。早期诊断和治疗对于预防原发性UEDVT中的PTS至关重要；然而，对于哪种治疗方法最佳尚无共识。抗凝治疗至少3至6个月仍被视为首选治疗方法，除非随机对照试验另有证明。
