Deep Vein Thrombosis of the Arms

Deep vein thrombosis is often regarded as a disease limited of the veins of the lower extremities, which may sometimes – in more severe cases extend to the pelvic veins. Although this holds true for over 90% of all thromboses, clinically relevant thromboses may be found in virtually every vein system of the body. Of these uncommon localisations of thromboses, deep vein thrombosis of the arms is one of the most frequent entities, accounting for about 5% of all thromboses (Munoz et al., 2008; Isma et al., 2010). Most cases of deep arm vein thrombosis develop secondary in patients with indwelling central venous catheters, pacemakers, malignant disease, or after surgery. Conversely, primary upper extremity deep venous thrombosis is observed in patients after strenuous arm exercise (“thrombosis par effort”), in thoracic outlet syndrome and inherited or acquired thrombophilia (Bernardi et al., 2006). Acute and long-time complications of upper extremity thrombosis may be significant and include pulmonary embolism, post-thrombotic syndrome and recurrent thromboembolism. In this chapter, the clinical presentation, diagnostic procedures, treatment and prevention of thromboses of the upper extremity will be reviewed. It is not unusual to find thromboses of proximal arm veins and deep veins of the neck region at the same time. Therefore, thromboses of the internal jugular vein, which are also most often observed in the presence of indwelling central venous catheters, will also be discussed. In this review, special emphasis will be given to the practical aspects of the disease, like risk factors, clinical presentation, diagnosis, and treatment of arm vein thrombosis. For a detailed, comprehensive overview of pathophysiological mechanisms, the reader will be referred to other, excellent reviews within this field.