From the Guidelines
Deep vein thrombosis (DVT) of the arm most commonly affects the axillary and subclavian veins. These large veins are part of the deep venous system of the upper extremity and are responsible for draining blood from the arm back to the heart. While other arm veins such as the brachial, ulnar, and radial veins can also develop thrombosis, the axillary-subclavian segment is the most frequently affected site. This pattern occurs because these larger veins are subject to compression between the first rib and clavicle (thoracic outlet), especially during arm movement or in cases of anatomical abnormalities. Upper extremity DVT is often associated with central venous catheters, pacemaker leads, or other indwelling devices that can damage the vessel wall, as noted in studies such as 1 and 1. It may also develop due to repetitive arm movements (effort thrombosis or Paget-Schroetter syndrome), malignancy, or hypercoagulable states. Symptoms typically include arm swelling, pain, discoloration, and visible collateral veins in the affected limb.
The diagnosis and management of upper extremity DVT have been discussed in various guidelines, including those from the American College of Chest Physicians 1 and the National Comprehensive Cancer Network 1. These guidelines suggest that anticoagulation therapy is the mainstay of treatment for upper extremity DVT, with the duration of therapy depending on the underlying cause and patient factors. For example, patients with cancer-associated thrombosis may require longer durations of anticoagulation, as suggested by 1.
In terms of specific veins affected, the axillary and subclavian veins are the most commonly involved, as they are more prone to compression and damage from indwelling devices or anatomical abnormalities. However, other veins such as the brachial, ulnar, and radial veins can also be affected, especially in cases of central venous catheter-associated thrombosis. The management of these cases may involve catheter removal, anticoagulation, and possibly thrombolysis, depending on the severity of the thrombosis and the patient's overall condition, as discussed in studies such as 1 and 1.
Overall, the management of upper extremity DVT requires a comprehensive approach, taking into account the underlying cause, patient factors, and the specific veins affected. The axillary and subclavian veins are the most commonly affected veins in upper extremity DVT, and treatment typically involves anticoagulation therapy, with the goal of preventing recurrent thrombosis and reducing the risk of long-term complications such as post-thrombotic syndrome.
From the Research
Vein Affected in DVT of the Arm
The vein typically affected in Deep Vein Thrombosis (DVT) of the arm is:
- The subclavian vein
- The axillary vein
Causes and Symptoms
DVT of the arm can be caused by:
- Thoracic outlet anatomic obstruction, such as Paget-Schroetter syndrome (primary)
- Central intravenous catheters (secondary) 2, 3 Symptoms may include acute severe pain and arm swelling, although it can also be asymptomatic 3
Diagnosis and Treatment
Diagnosis is typically confirmed by diagnostic imaging procedures such as duplex ultrasound, computed tomography scan, or magnetic resonance imaging 3 Treatment usually involves anticoagulant therapy, and may also include early thrombolysis and thoracic outlet decompression surgery for primary DVT 2, 3 In cases of catheter-related thrombosis, anticoagulation without thrombolysis is often the treatment of choice, and mandatory functioning catheters can remain in place with anticoagulant treatment 3, 4