Management of Upper Extremity DVT

Abstract

Upper extremity deep venous thrombosis (UEDVT) represents 4 to 11% of all deep vein thrombosis (DVT) and can result in persistent pain, swelling, and disability if inadequately treated. The range of presentations varies, from acute pain and swelling in the young overhead athlete to the asymptomatic cancer patient with chronic catheter-associated thrombus. Given the range of presentations, it is important to be familiar with the multimodal therapeutic options for UEDVT to appropriately select patients who will benefit from intervention. This is vitally important as use of central venous access devices and imaging increases, resulting in increased incidence and detection of UEDVT.

Keywords

Paget-Schroetter syndrome - upper extremity DVT - interventional radiology - thrombolysis

Publication History

Article published online:
09 October 2025

• References

• 1 Feinberg J, Nielsen EE, Jakobsen JC. Thrombolysis for acute upper extremity deep vein thrombosis. Cochrane Database Syst Rev 2017; 12 (12) CD012175
• 2 Cote LP, Greenberg S, Caprini JA. et al; RIETE Investigators. Comparisons between upper and lower extremity deep vein thrombosis: a review of the RIETE registry. Clin Appl Thromb Hemost 2017; 23 (07) 748-754
• 3 Ageno W, Haas S, Weitz JI. et al. Upper extremity DVT versus lower extremity DVT: perspectives from the GARFIELD-VTE registry. Thromb Haemost 2019; 119 (08) 1365-1372
• 4 Moyer E, Bernard K, Gottlieb M. Epidemiology of deep venous thrombosis among United States emergency departments over an eight-year period. Clin Exp Emerg Med
• 5 Lee JA, Zierler BK, Zierler RE. The risk factors and clinical outcomes of upper extremity deep vein thrombosis. Vasc Endovascular Surg 2012; 46 (02) 139-144
• 6 Mumoli N, Dentali F, Conte G. et al. Upper extremity deep vein thrombosis in COVID-19: incidence and correlated risk factors in a cohort of non-ICU patients. PLoS One 2022; 17 (01) e0262522
• 7 Kucher N. Clinical practice. Deep-vein thrombosis of the upper extremities. N Engl J Med 2011; 364 (09) 861-869
• 8 Koethe Y, Bochnakova T, Kaufman CS. Upper extremity deep venous thrombosis: etiologies, diagnosis, and updates in therapeutic strategies. Semin Intervent Radiol 2022; 39 (05) 475-482
• 9 Paget J. On gouty and some other forms of phlebitis. St Bartholomews Hosp Rep 1866; 2: 82-92
• 10 von Schroetter L. Erkrankungen der Gafasse. Erkrank Gefässe Nothnagels Handb Speciellen Pathol Ther 2025; 15: 533-535
• 11 Hughes ESR. Venous obstruction in the upper extremity; Paget-Schroetter's syndrome; a review of 320 cases. Surg Gynecol Obstet 1949; 88 (02) 89-127
• 12 Drapanas T, Curran WL. Thrombectomy in the treatment of “effort” thrombosis of the axillary and subclavian veins. J Trauma 1966; 6 (01) 107-119
• 13 Lungu AM, Andrei IM, Uscoiu G, Grigore M, Iliesiu AM. A rare cause of deep vein thrombosis in a young orchestra conductor. Diagnostics (Basel) 2024; 14 (04) 354
• 14 Starčević N, Petrović T, Pavlović T, Klarić D, Primorac D. McCleery syndrome caused by pectoralis minor hypertrophy treated with multimodal physical therapy—a case report. J Clin Med 2024; 13 (10) 2894
• 15 Bosch FTM, Nisio MD, Büller HR, van Es N. Diagnostic and therapeutic management of upper extremity deep vein thrombosis. J Clin Med 2020; 9 (07) 2069
• 16 Decousus H, Bourmaud A, Fournel P. et al; ONCOCIP Investigators. Cancer-associated thrombosis in patients with implanted ports: a prospective multicenter French cohort study (ONCOCIP). Blood 2018; 132 (07) 707-716
• 17 Puri A, Dai H, Giri M, Wu C, Huang H, Zhao Q. The incidence and risk of venous thromboembolism associated with peripherally inserted central venous catheters in hospitalized patients: a systematic review and meta-analysis. Front Cardiovasc Med 2022; 9: 917572
• 18 Lu H, Yang Q, Yang L. et al. The risk of venous thromboembolism associated with midline catheters compared with peripherally inserted central catheters: a systematic review and meta-analysis. Nurs Open 2022; 9 (03) 1873-1882
• 19 Wang P, Soh KL, Ying Y, Liu Y, Huang X, Huang J. Risk of VTE associated with PORTs and PICCs in cancer patients: a systematic review and meta-analysis. Thromb Res 2022; 213: 34-42
• 20 Bahl A, Alsbrooks K, Gala S, Hoerauf K. Symptomatic deep vein thrombosis associated with peripherally inserted central catheters of different diameters: a systematic review and meta-analysis. Clin Appl Thromb Hemost 2023; 29: 10 760296221144041
• 21 van Rooden CJ, Schippers EF, Barge RMY. et al. Infectious complications of central venous catheters increase the risk of catheter-related thrombosis in hematology patients: a prospective study. J Clin Oncol 2005; 23 (12) 2655-2660
• 22 Muñoz FJ, Mismetti P, Poggio R. et al; RIETE Investigators. Clinical outcome of patients with upper-extremity deep vein thrombosis: results from the RIETE Registry. Chest 2008; 133 (01) 143-148
• 23 Yamashita Y, Morimoto T, Amano H. et al; COMMAND VTE Registry Investigators. Deep vein thrombosis in upper extremities: clinical characteristics, management strategies and long-term outcomes from the COMMAND VTE Registry. Thromb Res 2019; 177: 1-9
• 24 Constans J, Salmi LR, Sevestre-Pietri MA. et al. A clinical prediction score for upper extremity deep venous thrombosis. Thromb Haemost 2008; 99 (01) 202-207
• 25 Lim W, Le Gal G, Bates SM. et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism. Blood Adv 2018; 2 (22) 3226-3256
• 26 Middeldorp S, Nieuwlaat R, Baumann Kreuziger L. et al. American Society of Hematology 2023 guidelines for management of venous thromboembolism: thrombophilia testing. Blood Adv 2023; 7 (22) 7101-7138
• 27 Nicolaides AN, Fareed J, Spyropoulos AC. et al. Prevention and management of venous thromboembolism. International Consensus Statement. Guidelines according to scientific evidence. Int Angiol 2024; 43 (01) 1-222
• 28 Desjardins B, Hanley M, Steigner ML. et al; Expert Panel on Vascular Imaging. ACR Appropriateness Criteria® suspected upper extremity deep vein thrombosis. J Am Coll Radiol 2020; 17 (5S): S315-S322
• 29 Sartori M, Migliaccio L, Favaretto E. et al. Whole-arm ultrasound to rule out suspected upper-extremity deep venous thrombosis in outpatients. JAMA Intern Med 2015; 175 (07) 1226-1227
• 30 Needleman L, Feld R. Peripheral venous ultrasound. Radiol Clin North Am 2025; 63 (01) 165-178
• 31 Gillet R, Teixeira P, Meyer JB. et al. Dynamic CT angiography for the diagnosis of patients with thoracic outlet syndrome: correlation with patient symptoms. J Cardiovasc Comput Tomogr 2018; 12 (02) 158-165
• 32 de Jong CMM, van Dam LF, Dronkers CEA. et al. Use of magnetic resonance direct thrombus imaging for the diagnostic management of suspected thrombosis in routine clinical practice. TH Open 2024; 8 (03) e266-e272
• 33 Ge J, Weng C, Zhao J, Yuan D, Wang T. Upper extremity phlegmasia cerulea dolens complicating supra vena cava embolism in a cervical cancer patient: case report. Front Cardiovasc Med 2024; 11: 1351358
• 34 Thiyagarajah K, Ellingwood L, Endres K. et al. Post-thrombotic syndrome and recurrent thromboembolism in patients with upper extremity deep vein thrombosis: a systematic review and meta-analysis. Thromb Res 2019; 174: 34-39
• 35 Ende-Verhaar YM, Tick LW, Klok FA. et al. Post-thrombotic syndrome: short and long-term incidence and risk factors. Thromb Res 2019; 177: 102-109
• 36 Espitia O, Raimbeau A, Planquette B. et al. A systematic review and meta-analysis of the incidence of post-thrombotic syndrome, recurrent thromboembolism, and bleeding after upper extremity vein thrombosis. J Vasc Surg Venous Lymphat Disord 2024; 12 (01) 101688
• 37 Khan O, Marmaro A, Cohen DA. A review of upper extremity deep vein thrombosis. Postgrad Med 2021; 133 (sup1): 3-10
• 38 Newton DH, Monreal Bosch M, Amendola M. et al; RIETE Investigators. Analysis of noncatheter-associated upper extremity deep venous thrombosis from the RIETE registry. J Vasc Surg Venous Lymphat Disord 2017; 5 (01) 18-24.e1
• 39 Lamontagne F, McIntyre L, Dodek P. et al; Prophylaxis for Thromboembolism in Critical Care Trial Investigators, Canadian Critical Care Trials Group, Australian and New Zealand Intensive Care Society Clinical Trials Group. Nonleg venous thrombosis in critically ill adults: a nested prospective cohort study. JAMA Intern Med 2014; 174 (05) 689-696
• 40 Stevens SM, Woller SC, Kreuziger LB. et al. Antithrombotic therapy for VTE disease: second update of the CHEST Guideline and Expert Panel Report. Chest 2021; 160 (06) e545-e608
• 41 Porfidia A, Agostini F, Giarretta I. et al. Upper extremity deep vein thrombosis treated with direct oral anticoagulants: a multi-center real world experience. J Thromb Thrombolysis 2020; 50 (02) 355-360
• 42 Lyman GH, Carrier M, Ay C. et al. American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer. Blood Adv 2021; 5 (04) 927-974
• 43 Ortel TL, Neumann I, Ageno W. et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv 2020; 4 (19) 4693-4738
• 44 Watson L, Broderick C, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev 2016; 11 (11) CD002783
• 45 Vedantham S, Goldhaber SZ, Julian JA. et al; ATTRACT Trial Investigators. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med 2017; 377 (23) 2240-2252
• 46 Broderick C, Watson L, Armon MP. Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb. Cochrane Database Syst Rev 2021; 1 (01) CD002783
• 47 Machleder HI. Evaluation of a new treatment strategy for Paget-Schroetter syndrome: spontaneous thrombosis of the axillary-subclavian vein. J Vasc Surg 1993; 17 (02) 305-315 , discussion 316–317
• 48 Molina JE, Hunter DW, Dietz CA. Paget-Schroetter syndrome treated with thrombolytics and immediate surgery. J Vasc Surg 2007; 45 (02) 328-334
• 49 Vik A, Holme PA, Singh K. et al. Catheter-directed thrombolysis for treatment of deep venous thrombosis in the upper extremities. Cardiovasc Intervent Radiol 2009; 32 (05) 980-987
• 50 Dadashzadeh ER, Ohman JW, Kavali PK, Henderson KM, Goestenkors DM, Thompson RW. Venographic classification and long-term surgical treatment outcomes for axillary-subclavian vein thrombosis due to venous thoracic outlet syndrome (Paget-Schroetter syndrome). J Vasc Surg 2023; 77 (03) 879-889.e3
• 51 Chun TT, O'Connell JB, Rigberg DA. et al. Preoperative thrombolysis is associated with improved vein patency and functional outcomes after first rib resection in acute Paget-Schroetter syndrome. J Vasc Surg 2022; 76 (03) 806-813.e1
• 52 Hoexum F, Hoebink M, Coveliers HME, Wisselink W, Jongkind V, Yeung KK. Management of Paget-Schroetter syndrome: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg 2023; 66 (06) 866-875
• 53 Kearon C, Akl EA, Comerota AJ. et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 Suppl): e419S-e496S
• 54 Mahmoud O, Vikatmaa P, Räsänen J. et al. Catheter-directed thrombolysis versus pharmacomechanical thrombectomy for upper extremity deep venous thrombosis: a cost-effectiveness analysis. Ann Vasc Surg 2018; 51: 246-253
• 55 Fuller T, Neville E, Shapiro J. et al. Comparison of aspiration thrombectomy to other endovascular therapies for proximal upper extremity deep venous thrombosis. J Vasc Surg Venous Lymphat Disord 2022; 10 (02) 300-305
• 56 Sweeney AM, Makary MS, Greenberg C. et al. Percutaneous thrombectomy of upper extremity and thoracic central veins using Inari ClotTriever System: experience in 14 patients. J Vasc Surg Cases Innov Tech 2023; 9 (01) 101096
• 57 Bashir M, Tan SZ, Jubouri M. et al. A narrative review of the surgical management of Paget-Schroetter syndrome: case series and long-term follow-up. Cardiovasc Diagn Ther 2022; 12 (05) 744-755
• 58 Bach K, Miller MA, Allgier A, Al Muhtaseb T, Little KJ, Schwentker AR. Thoracic outlet syndrome in the pediatric and young adult population. J Hand Surg Am 2024; 49 (04) 337-345
• 59 Deveze E, Ammi M, Hersant J. et al. Ten-year experience of surgical management of Paget-Schroetter syndrome. Ann Vasc Surg 2023; 96: 328-334
• 60 Urschel Jr HC, Patel AN. Surgery remains the most effective treatment for Paget-Schroetter syndrome: 50 years' experience. Ann Thorac Surg 2008; 86 (01) 254-260 , discussion 260
• 61 de Kleijn RJCMF, Schropp L, Westerink J, de Borst GJ, Petri BJ. Timing of thoracic outlet decompression after thrombolysis for primary upper extremity deep venous thrombosis: a systematic review. Ann Vasc Surg 2020; 66: 654-661
• 62 Schropp L, de Kleijn RJCMF, Westerink J. et al; TROTS registry collaborators. Thoracic outlet syndrome (TROTS) registry: a study protocol for the primary upper extremity deep venous thrombosis section. PLoS One 2023; 18 (01) e0279708
• 63 Zurkiya O, Donahue DM, Walker TG, Ganguli S. Safety and efficacy of catheter-directed therapies as a supplement to surgical decompression in venous thoracic outlet syndrome. AJR Am J Roentgenol 2018; 210 (02) W80-W85
• 64 Rajendran S, Cai TY, Loa J, Saha P, Dubenec S. Early outcomes using dedicated venous stents in the upper limb of patients with venous thoracic outlet syndrome: a single centre experience. CVIR Endovasc 2019; 2 (01) 22
• 65 Debourdeau P, Farge D, Beckers M. et al. International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer. J Thromb Haemost 2013; 11 (01) 71-80
• 66 Matos JM, Gonzalez L, Kfoury E, Echeverria A, Bechara CF, Lin PH. Outcomes following operative management of thoracic outlet syndrome in the pediatric patients. Vascular 2018; 26 (04) 410-417
• 67 Avila L, Amiri N, De R. et al. Characteristics of upper- and lower-extremity deep vein thrombosis and predictors of postthrombotic syndrome in children. Blood Adv 2021; 5 (19) 3737-3747
• 68 Modi BP, Chewning R, Kumar R. Venous thoracic outlet syndrome and Paget-Schroetter syndrome. Semin Pediatr Surg 2021; 30 (06) 151125
• 69 Lee JT, Karwowski JK, Harris EJ, Haukoos JS, Olcott IV C. Long-term thrombotic recurrence after nonoperative management of Paget-Schroetter syndrome. J Vasc Surg 2006; 43 (06) 1236-1243
• 70 Corrales-Medina FF, Raffini L, Recht M, Santos J, Thornburg CD, Davila J. Direct oral anticoagulants in pediatric venous thromboembolism: experience in specialized pediatric hemostasis centers in the United States. Res Pract Thromb Haemost 2022; 7 (01) 100001
• 71 Pesser N, Bode A, Goeteyn J. et al. Surgical management of post-thrombotic syndrome in chronic venous thoracic outlet syndrome. J Vasc Surg Venous Lymphat Disord 2021; 9 (05) 1159-1167.e2
• 72 Chapman SC, Singh MJ, Lowenkamp MN, Brown JA, Eslami MH. Postoperative outcomes in thoracic outlet decompression for acute versus chronic venous thoracic outlet syndrome. J Vasc Surg Venous Lymphat Disord 2021; 9 (02) 321-328