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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