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Catheter-related upper extremity venous thrombosis

Authors
Caroline Bérubé, MD
James L Zehnder, MD
Section Editors
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

Intravenous catheters cause endothelial trauma and inflammation, which can lead to venous thrombosis. The majority (70 to 80 percent) of thrombotic events occurring in the superficial and deep veins of the upper extremity are due to the presence of intravenous catheters. The remainder is due to mechanical compression from anatomic abnormalities (ie, venous thoracic outlet syndrome) [1-3].

Superficial thrombophlebitis due to peripheral catheters is generally self-limited once the catheter is removed. Thrombosis involving the deep veins (ie, subclavian, axillary, brachial) can lead to pulmonary embolism and long-term sequelae in spite of adequate therapy [4]. Pulmonary embolism from upper extremity sources accounts for about 6 percent of cases [5-7].

Upper extremity venous thrombosis (superficial and deep) as a complication of indwelling venous catheters will be reviewed here. Thrombosis involving the lower extremity veins is discussed elsewhere. (See "Phlebitis and thrombosis of the superficial lower extremity veins" and "Diagnosis of suspected deep vein thrombosis of the lower extremity".)

General issues regarding deep venous thrombosis, primary causes of upper extremity deep venous thrombosis, and thrombosis related to hemodialysis access are also discussed elsewhere. (See "Overview of the causes of venous thrombosis" and "Primary (spontaneous) upper extremity deep vein thrombosis" and "Central catheters for acute and chronic hemodialysis access".)

VENOUS ANATOMY

The upper extremity veins are divided into the superficial and deep systems (figure 1).

                                       

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