![]() UEDVT is classified as primary or secondary on the basis of pathogenesis. UEDVT most commonly refers to thrombosis of the axillary and/or subclavian veins. UEDVT has been reported in up to one fourth of patients with these catheters.3 For these reasons, it is imperative that physicians understand UEDVT risk factors, diagnostic options, treatment alternatives, and prophylaxis regimens. This is directly related to the increasing use of central venous catheters for chemotherapy, bone marrow transplantation, dialysis, and parenteral nutrition. Pulmonary embolism (PE) is present in up to one third of patients with UEDVT.1 Other complications, such as persistent upper-extremity pain and swelling, the superior vena cava (SVC) syndrome, and loss of vascular access, can be disabling and devastating.2 Although once considered rare, UEDVT has become more common over the past several decades. Upper-extremity deep vein thrombosis (UEDVT) is an increasingly important clinical entity with potential for considerable morbidity. ![]() The rate of asymptomatic catheter-related DVT is high and could be lowered with correct initial CVC positioning. The side on which the CVC was implanted did not influence the catheter-related DVT rate. Only five of 87 patients with a correctly positioned distal catheter tip (ie, either in the superior vena cava or at the junction between the right atrium and the superior vena cava) developed thrombosis, compared with 12 of 26 patients with a misplaced catheter (P <.001). Correct positioning of the distal catheter tip was associated with a significantly lower rate of catheter-related DVT. The mean interval between CVC implantation and detection of thrombosis was 42.2 days. Seventeen patients developed catheter-related DVT 13 of them were asymptomatic. Follow-up included (a) estimation of the position of each catheter tip on a chest radiograph obtained immediately after surgery and (b) regular monthly Doppler US screening for catheter-related DVT. This prospective study extending for more than 3 years had two objectives: (a) to use Doppler ultrasonography (US) to estimate the incidence of asymptomatic catheter-related upper extremity deep venous thrombosis (DVT) in a large population and (b) to study the effect of the catheter position as an individual risk factor for catheter-related DVT.Ä«etween October 1995 and June 1998, a total of 145 patients who had oropharyngeal tract cancer and who were fitted with the same totally implantable central venous catheters (CVCs) were included in the study.
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