In order to elucidate the natural history of upper extremity deep venous th
rombosis (UEDVT), we compared the morbidity and mortality of patients with
UEDVT and that of patients with both UEDVT and lower extremity deep venous
thrombosis (LEDVT). Between 1993 and 1996, 21 patients presented to our ins
titution with both LEDVT and UEDVT (Group 1). During the same time period,
144 patients were diagnosed with UEDVT alone (Group 2). The diagnosis was c
onfirmed by duplex scanning in all patients.
In Group 1. there were 14 females (67%) and 7 males (23%) with ages ranging
from 25 to 97 yr old [mean 73 yr old +/- 17 yr (SD)]. In Group 2. there we
re 84 females (58%) and 60 males (42%) with ages ranging from 9 to 101 yr o
ld [mean 67 yr old +/- 17 yr (SD)]. Differences in age and sex between the
two groups were not statistically significant. In Group 1, systemic anticoa
gulation was implemented in 17 patients (81%). Two patients (9.5%) required
placement of a SVC and IVC filters due to contraindication to anticoagulat
ion. One patient did not receive anticoagulation, and one patient was only
started on aspirin. In Group 2, treatment consisted of systemic anticoagula
tion in 94 patients (65%). The remainder of the patients were treated with
aspirin in three patients (2%) or no anticoagulation in 31 patients (19%).
Sixteen patients (11%) underwent placement of a SVC filter either due to fa
ilure of anticoagulation to prevent pulmonary embolism (two patients) or co
ntraindication to anticoagulation (14 patients).
Pulmonary emboli were documented by ventilation/perfusion lung scan in two
patients (9.5%) in Group 1 and in 16 patients (11%) in Group 2. In the firs
t group. 8 of the 21 patients (38%) were dead within I month of the diagnos
is of UEDVT, and 11 of 21 patients (52%) were dead within 2 months of the d
iagnosis of UEDVT. In the second group, 20 of 144 patients (14%) were dead
within I month of the diagnosis of UEDVT and 38 of 144 patients (26%) were
dead within 2 months of diagnosis (P <0.02).
Our data suggest that patients with both UEDVT and LEDVT have a higher mort
ality than patients with UEDVT alone. As the risk for pulmonary embolism is
similar in both groups, we speculate that the severity of medical illness
in patients with both UEDVT and LEDVT may contribute to the higher mortalit
y. This is the first study to examine the mortality of this group of patien
ts. (C) 2001 The International Society for Cardiovascular Surgery. Publishe
d by Elsevier Science Ltd. All rights reserved.