Introduction and objective: Upper extremity deep vein thrombosis (UEDVT) accounts for ۱ to ۴% of deep vein thrombosis (DVT) cases and can be associated with complications and mortality. This study aims to review the upper extremity DVT
diagnosis methods and evaluate the sensitivity and specificity of commonly available diagnostic tests for upper extremity DVT that can be used to provide a combined
diagnosis strategy.
Method: Articles in this study, national databases including Magiran, SID, and IranMedex, as well as international databases including PubMed, Google Scholar, Scopus, and ISI databases, were searched for related books and articles. Keywords including upper extremity deep vein thrombosis, thrombolysis, diagnosis, upper extremity deep vein thrombosis, thrombolysis, and
diagnosis were searched. After reviewing the studies based on the inclusion and exclusion criteria, ۲۰ articles that were common in different databases and overlapped were discarded, and finally, ۵۰ articles were reviewed.
Findings: Diagnostic methods to identify UEDVT include D-dimer, duplex ultrasound, venography, contrast-enhanced computed tomography (CT), and magnetic resonance
imaging (MRI). The accuracy of the
D-dimer test for the
diagnosis of UEDVT was evaluated in two studies. The sensitivity and specificity of
D-dimer with a cut-off value of ۵۰۰ micrograms per liter are ۱۰۰% (۹۵% CI, ۷۸% to ۱۰۰%), ۱۴% (۹۵% CI, ۴% to ۲۹%), ۹۲% (۹۵% CI), ۷۳% to ۹۹%) and ۶۰% (۹۵% CI, ۵۲% to ۶۷%). Duplex ultrasound, a noninvasive and widely available technique that uses Doppler technology to assess flow in vessels, has become the first line of diagnosis. The combined sensitivity and specificity of different ultrasound methods were, respectively, ۸۴% (۹۵% CI, ۷۲% to ۹۷%) and ۹۴% (۹۵% CI, ۸۶% to ۱۰۰%) for non-compression Doppler ultrasound, ۹۷% (۹۵% CI, ۹۰ to ۱۰۰%) and ۹۶% (۹۵% CI, ۸۷ to ۱۰۰%) for compression ultrasound, and ۹۱% (۹۵% CI, ۸۵ to ۹۷%) and ۹۳% (۹۵% CI, ۸۰ to ۱۰۰%) for compression Doppler ultrasound.
Conclusion: UEDVT is an increasing clinical problem and requires accurate and rapid
diagnosis to prevent complications such as recurrence, post-thrombotic syndrome (PTS), and pulmonary embolism. Clinical suspicion should be confirmed by diagnostic
imaging methods such as duplex ultrasound, computed tomography (CT) scan, or MRI. A diagnostic strategy based on sequential evaluation of clinical factors and
D-dimer test can avoid
imaging in about a quarter of patients. Ultrasound is widely used as a first-line
imaging test and, if inconclusive, may be followed by a second ultrasound, CT venography, or MRI.