| Upper Extremity Deep Vein Thrombosis: The Oft-forgotten Cousin of Venous Thromboembolic Disease. | |
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MedLine Citation:
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PMID: 21271312 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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OPINION STATEMENT: Upper extremity deep venous thrombosis (UEDVT) accounts for between 4% and 10% of all deep venous thromboses, and may be due to primary or secondary causes. The incidence of UEDVT is increasing, partly due to the exponential growth in the use of central venous catheters and the increasing placement of permanent cardiac pacemaker or defibrillator devices. UEDVT not only compromises future vascular access but results in significant morbidity and mortality, with symptomatic pulmonary embolus occurring in approximately 12%, post-thrombotic syndrome in 13%, and mortality ranging from 15-50%. Treatment of UEDVT depends on the underlying cause, primary or secondary. In this review, we will evaluate the management options and present a proposed treatment algorithm for primary UEDVT, involving catheter-directed thrombolysis, selective use of mechanical thrombectomy, anticoagulation and antithrombotic therapy, expeditious early first rib resection to decompress the thoracic outlet, and the role of adjunctive endovascular balloon angioplasty and stenting in improving axillo-subclavian vein patency. With regard to secondary UEDVT, we will present a treatment algorithm for managing central venous catheter (CVC) thrombosis; review the options for antithrombotic and anticoagulant therapy; and discuss the role of endovascular therapy. Finally, we will review the data supporting the growing role of percutaneous transluminal angioplasty (PTA) or venoplasty and endovascular stenting as the modality of choice in managing SVC obstruction, whether due to benign or malignant causes, and provide a brief description of the role, benefits and potential complications of SVC filter placement. |
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Authors:
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Ronan Margey; Robert M Schainfeld |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-1-27 |
Journal Detail:
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Title: Current treatment options in cardiovascular medicine Volume: - ISSN: 1534-3189 ISO Abbreviation: - Publication Date: 2011 Jan |
Date Detail:
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Created Date: 2011-1-28 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9815942 Medline TA: Curr Treat Options Cardiovasc Med Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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Section of Vascular Medicine, Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Gray-Bigelow 800, 55 Fruit Street, Boston, MA, 02114, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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