Principal Investigator: Angela Kirkpatrick, MD

Abstract:

Upper extremity deep venous thrombosis is an increasingly recognized clinical problem that may cause important pulmonary embolism that could be fatal.  The clinical diagnosis of UEDVT is nonspecific.  The prevalence of UEDVT is less than 50% among symptomatic patients necessitating objective testing to confirm or exclude the diagnosis.  While venography remains the diagnostic reference standard, it is invasive, has an associated risk of thrombophlebitis, and may be unavailable or impractical.  Ultrasonography is the most frequently used objective test for UEDVT.  However, in contrast to patients with lower extremity DVT, the validity of diagnostic ultrasonsography is uncertain.  Anatomical differences between the upper and lower extremity deep venous system may influence the performance characteristics of ultrasonography for the diagnosis of UEDVT.  The ability to image and compress the mid-subclavian vein is hindered by the overlying segment of the clavicle.  Most commonly, ultrasonographic imaging includes evaluation of the subclavian and axillary veins, as well as the internal jugular, inominate, brachial, and basilic veins.  Currently there are no standard uniformly accepted diagnostic criteria for UEDVT.  Real time ultrasonography imaging is used to assess the presence or absence of vein compressibility and echogenicity within the vein lumen.  Doppler ultrasonography evaluates the characteristics of venous flow including phasicity, pulsability, and variation with physiologic maneuvers.  Color-flow imaging has enabled the assessment of the presence and direction of venous flow.  A recent systematic review of the literature concluded there is a need for data about the safety of withholding anticoagulant treatment in a patient with suspected UEDVT and negative ultrasonography.

Patient Inclusion Criteria:

1. Patients with suspected upper extremity deep venous thrombosis (UEDVT)

Patient Compensation:

Contact Information:

Angelia Kirkpatrick, MD (405) 271-4742