Upper extremity deep vein thrombosis: An intensivist’s perspective

Table 1 Risk factors for developing upper extremity deep vein thrombosis

Risk factors
Central venous catheters/dialysis catheters
Implantable cardiac rhythm devices
Personal or family history of thrombosis and thrombophilia
Surgery or trauma of the arm
Immobilization of the arm
Pregnancy
Use of oral contraceptive
Malignancy
Post-operative e.g., esophagectomy, retrosternal reconstruction

Table 2 Constans clinical decision score

Patient characteristic	Score
Venous material present (CVC/pacemaker)	Yes	1 point
	No	0 point
Localised pain	Yes	1 point
	No	0 point
Unilateral oedema	Yes	1 point
	No	0 point
Other diagnosis at least as plausible	Yes	-1 point
	No	0 point
Risk for UEDVT
Low: 12% probability of UEDVT	-1 to 0 points1
Intermediate: 20% probability of UEDVT	1 point1
High: 70% probability of UEDVT	2-3 points1

¹Total score.

CVC: Central venous catheter; UEDVT: Upper extremity deep vein thrombosis.

Table 3 Advantages and disadvantages of various diagnostic tests for upper extremity deep vein thrombosis

Diagnostic tests	Advantages	Disadvantages
D-dimer	High sensitivity. Readily available	Poor specificity. Not extensively evaluated for UEDVT
Ultrasound	Non-invasive. Readily available. Bedside. Less expensive. Good sensitivity and specificity	Not appropriate for evaluating central veins. Operator dependant
Doppler ultrasound	Non-invasive. Readily available. Bedside. Less expensive. Good sensitivity and specificity	Operator dependant
Computed tomography venography	Can help in diagnosing other underlying pathologies or rule out other diagnosis	Radiation exposure. Logistical issues. Moderate sensitivity and specificity
Magnetic resonance venography	Can help in diagnosing other underlying pathologies or rule out other diagnosis	Not widely available. Expensive. Logistical issues. Not suitable for patients with surgical implants and pacemakers. Moderate sensitivity and specificity
Contrast venography	Gold standard. High sensitivity and specificity. Can visualize the entire deep venous system. Can define complex and difficult anatomy	Invasive. Radiation exposure. Allergic reactions

UEDVT: Upper extremity deep vein thrombosis.