What a coincidence.  This topic came up this morning and this morning I have
a RUE, acute, non occlusive thrombus that began at the antecubital fossa
(temp cath for HD access) and propagated to the proximal axillary and is
moving into the subclavian.  If I had watched long enough I think I could
have seen it grow.

-----Original Message-----
From: Don Ridgway [mailto:[log in to unmask]]
Sent: Wednesday, September 21, 2005 1:47 PM
To: [log in to unmask]
Subject: Re: ue venous


On Sep 20, 2005, at 7:21 PM, Lisa Mekenas wrote:

Don,
How much propagation,if seen, does it pose once the source-usually a picc
has been removed?

Good question. Next question.





 Also what is the incidence of PE from the UE? Deep vs superficial and both.


If we go with the usual figure of about 90% of PEs coming from LE veins,
then the incidence from UEs is obviously pretty small. I wonder if that
traditional 90% figure has changed in the last several years with the advent
of many more PICC lines and so forth. I have no idea regarding deep vs.
superficial embolization in the UE.




What about the article in the journal that stated that the basilic was a
deep vein?

Well, it runs sorta deep in the proximal upper arm in most folks, coursing
up to the superficial level a bit farther down. But that's neither here nor
there: through most of its course it runs superficial to the fascial
envelope and is therefore a superficial vein. 

And even if it needed redefining as a deep vein, my point would still be
that the distinction between superficial and deep is kind of irrelevant in
the UE.




And if the cephalic vein is thrombosed in a segment in the area above the
wrist or below the anticub-does it warrant a full heparin drip hospital
stay?(which in the real world is what you are saying as a lot of docs and
insurance companies do not allow Lovenox)

No, probably no more than an isolated calf clot warrants a big-deal hospital
admit. Put a warm compress on that baby and check again in a few days, would
be my suggestion if I were in a position to make it, which of course I'm not
because I'm not a physician, etc. etc.





What about the recanalization rates in the upper extremities vs the lower
extremities? Also the upper extremities have a much more varied distribution
of flow. Many patients have a dominant cephalic abv the anticub with a
dominant basilic below the anticub. I know what my experience has been with
UE,and the literature and what has been presented -your view is interesting.
Lisa

What is your experience? What do you think after all about the best way to
report these? You've done lots of work with Dr. Bergen, and I have a feeling
you have some useful perspective on this.


Don from across town
(also a happy member of the Sharp Family--catch the fire!)




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