What is an upper extremity deep vein thrombosis?
A deep vein thrombosis (DVT) occurs when a blood clot forms in a vein deep inside of your body. Blood clots can form when blood thickens and clumps together. If a blood clot does form, it’s possible for it to break off and travel through your bloodstream.
Sometimes, a clot can travel to your lungs and restrict blood flow. This is known as a pulmonary embolism (PE). Blood clots that form in your calves or pelvis are more likely to break off and cause a PE than clots in other areas.
If you’ve ever had to sit still for a long time, such as during a long airline flight, you may have heard about the risk of developing a blood clot in your leg and what to do about it. In different circumstances, it’s possible to develop this type of clot above your waist.
Upper extremity DVT (UEDVT) can appear in your neck or arms and travel to your lungs. This type of DVT can also lead to a PE.
What are the symptoms of a UEDVT?
The symptoms of a UEDVT are vague. This is because they also can be symptoms of other conditions. These symptoms may include:
- shoulder pain
- neck pain
- swelling of the arm or hand
- bluish skin color
- pain that travels to the arm or forearm
- hand weakness
Sometimes, UEDVT has no symptoms.
What are the causes of a UEDVT?
UEDVT has several possible causes:
Although strenuous activity can bring on a UEDVT, A UEDVT can also occur due to something as ordinary as carrying a heavy backpack. In particular, activities such as rowing or pitching a baseball can damage the inside coating of a blood vessel and cause a clot. This is known as a spontaneous UEDVT. These are generally rare.
When they do happen, this type of UEDVT typically shows up in young, otherwise healthy athletes. It typically occurs in men, but that ratio may change as more women get involved in athletics, notes Richard Becker, M.D., chief of the division of cardiovascular health and disease and director and physician-in-chief of the Heart, Lung and Vascular Institute at the University of Cincinnati College of Medicine. This causes about 20 percent of all UEDVTs.
A fracture involving the humerus, clavicle, or ribs or any trauma to the surrounding muscles can damage nearby blood vessels. This can result in a UEDVT.
Medical procedures such as the insertion of a pacemaker or central venous catheter can lead to UEDVT. This is a secondary cause of a UEDVT. One possible explanation is that a catheter, which is a thin, flexible tube, can damage blood vessels as your doctor inserts it or as it delivers medication. The presence of a foreign object in your vein can also restrict your blood flow. Restricted blood flow is a risk factor for DVT.
UEDVT may also occur in people who have a long-term catheter for medication or people who have a catheter above the waist for dialysis.
People who have a primary, or spontaneous, UEDVT due to strenuous activity may have an extra rib high in the chest or an abnormal muscle insertion. An extra rib is known as a cervical rib. It’s harmless in most circumstances, but it can irritate a vein or nerves with repeated motion, Becker says. The extra rib may be visible on an X-ray. Sometimes, a CT scan may be necessary for your doctor to see it.
Thoracic outlet syndrome can also cause a UEDVT. If you have this condition, your rib compresses your blood vessels and nerves as they leave your chest and enter your upper extremity.
Blood clotting disorders
Certain conditions can cause your blood to clot more than it normally should. When the blood clots too much, it’s said to be a hypercoagulable state. Certain genetic abnormalities can cause this. This may include conditions in which there’s a deficiency or abnormality of certain proteins involved in blood coagulation.
Sometimes, a UEDVT may develop due to another medical condition such as cancer or a connective tissue disorder such as lupus. Occasionally, a doctor may diagnose a DVT related to a cancer before they find the cancer. Researchers have documented a link between DVT, especially UEDVT, and previously undetected cancers.
Sometimes, a secondary UEDVT can develop for no apparent reason.
How is a UEDVT diagnosed?
People with a secondary UEDVT may be more likely to have conditions that cause blood to clot easily. Your doctor will look for other conditions linked with blood clotting in assessing your risk for a UEDVT.
Your doctor may use one or more of the following imaging tests to diagnose a UEDVT:
- an ultrasound
- a CT scan
- an MRI
How is a UEDVT treated?
Your doctor can treat a UEDVT with the following:
Doctors usually prescribe blood thinners for UEDVTs. A commonly prescribed blood thinner is warfarin (Coumadin). If you take Coumadin, you’ll need periodic blood tests to make sure your dose of Coumadin is correct.
Some newer blood thinners don’t require monitoring. This includes apixaban, rivaroxaban, and edoxaban. Your doctor may recommend that you continue to use it for one to six months. This depends on the location and severity of the clot, as well as its response to treatment.
Thrombolytics are drugs that can dissolve a blood clot. One option is to inject the drug into your vein so that your bloodstream carries the medicine to the clot. Another option is to thread a catheter carrying the medication through your vein directly to the blood clot. The catheter method works best if your doctor uses it less than two weeks after the first symptoms arise.
This method can lead to serious complications, such as internal bleeding and bleeding in the brain. Doctors usually reserve it for situations in which the clot is causing life-threatening complications.
Physical measures might also be appropriate for severe cases of UEDVT. In surgery for UEDVT, a doctor can cut open a vein and remove the clot. An alternative is to use a catheter to thread a balloon past the clot. When your doctor inflates the balloon, it’s possible they can drag the clot out of the vein. Physical interventions are risky. Doctors mainly use them to treat severe UEDVTs.
Your doctor might use a combination of these approaches to treat UEDVT. The best approach will depend on:
- your symptoms
- your age
- your general health
- the age of the clot
What is the outlook for people who have a UEDVT?
Primary UEDVT is less common than secondary UEDVT. Secondary UEDVT typically occurs with the insertion of a pacemaker or a central line catheter or with other medical procedures. If you get prompt diagnosis and treatment for a UEDVT, it will probably be manageable.