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Combined upper and lower extremity deep venous thrombosis.

A Hingorani1, E Ascher, M Ward

  • 1Division of Vascular Surgery, Department of Surgery, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219, USA.

Cardiovascular Surgery (London, England)
|August 8, 2001
PubMed
Summary

Patients with upper extremity deep venous thrombosis (UEDVT) and lower extremity deep venous thrombosis (LEDVT) have a significantly higher mortality rate compared to those with UEDVT alone. This suggests underlying medical conditions may drive poorer outcomes in combined cases.

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Area of Science:

  • Medical research
  • Vascular medicine
  • Thrombosis studies

Background:

  • Upper extremity deep venous thrombosis (UEDVT) is a condition affecting blood flow in the arm veins.
  • The natural history and comparative outcomes of UEDVT, particularly when co-occurring with lower extremity deep venous thrombosis (LEDVT), require further elucidation.

Purpose of the Study:

  • To compare the morbidity and mortality rates of patients diagnosed with both UEDVT and LEDVT against those with UEDVT alone.
  • To investigate factors contributing to differential outcomes in UEDVT patient cohorts.

Main Methods:

  • A retrospective study comparing two groups: 21 patients with UEDVT and LEDVT (Group 1) and 144 patients with UEDVT alone (Group 2) between 1993 and 1996.
  • Diagnosis of deep venous thrombosis (DVT) was confirmed using duplex scanning.

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  • Outcomes including mortality, pulmonary embolism incidence, and treatment strategies (anticoagulation, filters) were analyzed.

    • Main Results:

    • Patients with both UEDVT and LEDVT (Group 1) exhibited a significantly higher mortality rate within 1 and 2 months post-diagnosis compared to patients with UEDVT alone (Group 2) (52% vs. 26% at 2 months, P<0.02).
    • The incidence of pulmonary embolism was similar between the two groups (9.5% in Group 1 vs. 11% in Group 2).
    • Treatment strategies varied, with higher rates of anticoagulation in Group 1, but filter placement was also noted in both groups.

    Conclusions:

    • Co-occurrence of UEDVT and LEDVT is associated with a substantially increased mortality risk compared to UEDVT in isolation.
    • The similar rates of pulmonary embolism suggest that the heightened mortality in combined cases may be attributed to the severity of underlying medical illnesses rather than differences in thrombotic events.
    • This study highlights the critical prognostic significance of concurrent upper and lower extremity deep vein thrombosis.