Etiology and outcomes of upper extremity venous thrombosis: a retrospective cohort study

TL;DR

This study examines the causes and outcomes of upper extremity venous thrombosis, finding that deep vein thrombosis poses higher risks of complications like pulmonary embolism and death compared to superficial vein thrombosis.

Contribution

The study provides a detailed 5-year retrospective analysis of UEVT subtypes, identifying distinct etiological and outcome differences between UEDVT and UESVT.

Findings

UEDVT is strongly associated with malignancy, central venous catheters, and coagulopathies.

UEDVT has significantly higher rates of pulmonary embolism and mortality compared to UESVT.

Multivariate analysis identifies UEDVT, cancer, and age as key predictors of mortality.

Abstract

Upper extremity venous thrombosis (UEVT), encompassing upper extremity deep vein thrombosis (UEDVT) and superficial vein thrombosis (UESVT), is increasingly recognized due to invasive procedures and advanced diagnostics. This study characterizes the 5-year outcomes and etiological factors of UEVT in a large cohort.

We conducted a retrospective cohort study of 304 consecutive adult patients with acute UEVT (2019–2025) at a tertiary care center in Türkiye. Demographics, medical history, thrombosis characteristics, treatments, and outcomes—including thrombosis resolution, pulmonary embolism, and mortality—were analyzed. Statistical analyses were performed using chi-square tests, multivariate logistic regression, and random forest models.

Among the 304 patients, 4 (1.32%) had primary UEDVT, 115 (37.8%) had secondary UEDVT, 112 (36.8%) had nonfistula UESVT, and 73 (24.0%) had fistula-related UESVT. UEDVT was associated with malignancy (38.3%, n = 44), central venous catheters (25.2%, n = 29), rheumatologic disorders (n = 15), and coagulopathies (n = 10). Nonfistula UESVT was linked to local factors (e.g., IV contrast, n = 14; IV drug use, n = 12), with no pulmonary embolism (PE) or mortality. Fistula-related UESVT had a 1.4% PE and mortality rate. UEDVT showed higher PE (29.6% vs. 1.1%, p < 0.001) and mortality (23.5% vs. 0.5%, p < 0.001) than UESVT. Multivariate analysis identified UEDVT (OR = 36.50, 95% CI: 8.58%–155.31%), cancer (OR = 2.80), and heart failure (OR = 3.15) as PE predictors, while UEDVT (OR = 58.76), cancer (OR = 9.50), and age (OR = 1.05) were predictors of mortality (all p < 0.05).

UEDVT, driven by systemic factors, carries a higher risk of PE and mortality than UESVT, influenced by local factors. Thorough etiological evaluation and tailored interventions (e.g., catheter removal, multidisciplinary management) are critical to mitigate complications.

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