Marie I, Lévesque H, Cailleux N, Primard E, Peillon C, Watelet J, Courtois H
Département de médecine interne, Centre Hospitalier Universitaire de Rouen-Boisguillaume, France.
Rev Med Interne. 1998 Jun;19(6):399-408. doi: 10.1016/s0248-8663(98)80864-3.
Upper-extremity thrombosis appears to be more frequent today, comprising about 2% of all deep venous limb thrombosis. Its severity depends on the type of possible complications, i.e., pulmonary embolism and post-thrombotic sequelae. In this retrospective series, we investigated both the predisposing factors and the evolution of upper-extremity deep venous thrombosis.
Forty-nine consecutive patients (24 men and 25 women, mean age 50.2 years) with upper extremity deep venous thrombosis documented by color Doppler ultrasonography (n = 47) or phlebography (n = 2) were included in the study.
Clinical manifestations were mainly pain (81.6%) and edema (93.9%). Mean time between the onset of clinical signs and diagnosis was 7.2 days. Thrombosis involved humeral (26.5%), axillary (46.9%), subclavian (73.5%) and jugular (24.5%) veins. Causative factors were malignancies (32.7%), venous catheters (22.4%), deep venous thrombosis related to effort or thoracic outlet syndrome (22.5%) and thrombophilic states (8.2%). During the 6-month follow-up, six patients developed symptomatic pulmonary embolism (12.2%); one recurrence (2.2%) and 19 post-thrombotic sequelae such as residual edema (36.7%) were also observed. Initial therapy included heparin administration, principally subcutaneous low molecular weight heparins (n = 36/49).
This series highlights the fact that upper-extremity deep venous thrombosis is mainly secondary to either malignancies or catheterization. Moreover, it confirms that color Doppler ultrasonography may be useful in the diagnosis of the disease and also underlines the high frequency of severe complications, i.e., pulmonary embolism and post-thrombotic sequelae. Finally, this study also demonstrates that low molecular weight heparins should be considered as the initial treatment of choice.
如今上肢血栓形成似乎更为常见，约占所有肢体深静脉血栓形成的2%。其严重程度取决于可能的并发症类型，即肺栓塞和血栓形成后综合征。在这个回顾性系列研究中，我们调查了上肢深静脉血栓形成的易感因素及其演变过程。
本研究纳入了49例连续的上肢深静脉血栓形成患者（24例男性和25例女性，平均年龄50.2岁），这些患者通过彩色多普勒超声（n = 47）或静脉造影（n = 2）确诊。
临床表现主要为疼痛（81.6%）和水肿（93.9%）。临床症状出现至诊断的平均时间为7.2天。血栓累及肱静脉（26.5%）、腋静脉（46.9%）、锁骨下静脉（73.5%）和颈静脉（24.5%）。病因包括恶性肿瘤（32.7%）、静脉导管（22.4%）、与用力或胸廓出口综合征相关的深静脉血栓形成（22.5%）以及易栓症（8.2%）。在6个月的随访期间，6例患者发生了有症状的肺栓塞（12.2%）；观察到1例复发（2.2%）以及19例血栓形成后综合征，如残留水肿（36.7%）。初始治疗包括使用肝素，主要是皮下注射低分子肝素（n = 36/49）。
该系列研究突出了上肢深静脉血栓形成主要继发于恶性肿瘤或导管插入术这一事实。此外，证实了彩色多普勒超声在该病诊断中可能有用，也强调了严重并发症，即肺栓塞和血栓形成后综合征的高发生率。最后，本研究还表明低分子肝素应被视为初始治疗的首选。
