Prandoni P, Polistena P, Bernardi E, Cogo A, Casara D, Verlato F, Angelini F, Simioni P, Signorini G P, Benedetti L, Girolami A
Institute of Medical Semeiotics, University Hospital of Padua, Italy.
Arch Intern Med. 1997 Jan 13;157(1):57-62.
Little is known about the clinical, diagnostic, and prognostic aspects of upper-extremity deep vein thrombosis (UEDVT).
To identify the clinical and laboratory parameters associated with this disease, to assess the diagnostic accuracy of ultrasonographic methods for its detection, and to establish the frequency of both early and late complications.
After a careful history was taken, 58 consecutive patients with signs and symptoms that were clinically suggestive of UEDVT underwent the determination of antithrombin III and protein C and S levels and resistance to activated protein C and lupuslike anticoagulants. Compression ultrasonography, color flow Doppler imaging, and Doppler ultrasonography were performed prior to venography. Patients with confirmed UEDVT underwent objective tests to detect a pulmonary embolism and were followed up prospectively to record recurrent thromboembolic events and postthrombotic sequelae.
Findings from venography confirmed UEDVT in 27 patients (47%). Central venous catheters, thrombophilic states, and a previous leg vein thrombosis were statistically significantly associated with UEDVT. Sensitivity and specificity of compression ultrasonography (96% and 93.5%, respectively) and color flow Doppler imaging (100% and 93%, respectively) were comparable and better than those of Doppler ultrasonography (81% and 77%, respectively). Objective findings suggestive of a pulmonary embolism were recorded in 36% of the patients with UEDVT. After a mean follow-up of 2 years, 2 patients with UEDVT experienced recurrent thromboembolic events, and 4 had postthrombotic sequelae.
Symptomatic UEDVT is associated with central venous catheters, thrombophilic states, and a previous leg vein thrombosis. Both compression ultrasonography and color flow Doppler imaging are accurate methods for its detection. A pulmonary embolism is a common complication of the disease. Finally, this disorder may recur and may be followed by postthrombotic sequelae.
关于上肢深静脉血栓形成（UEDVT）的临床、诊断及预后方面，人们了解甚少。
确定与该疾病相关的临床和实验室参数，评估超声检查方法对其检测的诊断准确性，并确定早期和晚期并发症的发生率。
在详细询问病史后，对58例有临床提示UEDVT体征和症状的连续患者进行抗凝血酶III、蛋白C和S水平以及对活化蛋白C和狼疮样抗凝剂的抵抗性测定。在静脉造影前进行压迫超声检查、彩色多普勒血流成像及多普勒超声检查。确诊为UEDVT的患者接受客观检查以检测肺栓塞，并进行前瞻性随访以记录复发性血栓栓塞事件和血栓形成后综合征。
静脉造影结果证实27例患者（47%）存在UEDVT。中心静脉导管、血栓形成倾向状态及既往下肢静脉血栓形成与UEDVT在统计学上显著相关。压迫超声检查（分别为96%和93.5%）和彩色多普勒血流成像（分别为100%和93%）的敏感性和特异性相当，且优于多普勒超声检查（分别为81%和77%）。36%的UEDVT患者有提示肺栓塞的客观检查结果。平均随访2年后，2例UEDVT患者发生复发性血栓栓塞事件，4例出现血栓形成后综合征。
有症状的UEDVT与中心静脉导管、血栓形成倾向状态及既往下肢静脉血栓形成相关。压迫超声检查和彩色多普勒血流成像都是检测UEDVT的准确方法。肺栓塞是该疾病的常见并发症。最后，这种疾病可能复发，并可能继发血栓形成后综合征。
