PB0461 - Patient outcomes of catheter directed thrombolysis for upper extremity deep vein thrombosis

Background: Upper extremity deep vein thrombosis (UEDVT) accounts for < 10% of deep vein thrombosis (DVT). UEDVT can be idiopathic or can be due to thoracic outlet syndrome, thrombophilia, central venous catheter (CVC), oral contraceptives and cancer. Treatment recommendations are largely based on indirect evidence on the treatment of lower extremity DVT, with anticoagulation being the mainstay of treatment. Catheter directed thrombolysis (CDT) can potentially be considered in a minority of cases.

Aims: To evaluate immediate and medium term outcomes in UEDVT including recurrent venous thromboembolism (VTE) and clinically significant bleeding in patients receiving CDT.

Methods: Review of records of patients receiving CDT for UEDVT at St Thomas’ Hospital, London between December 2019 and November 2021 to extract information on risk factors, post procedure VTE recurrence and complications.

Results: 10 patients (median age 41.5 years) received CDT for UEDVT. 6 (60%) patients had thoracic outlet syndrome, 1 (10%) was idiopathic and 3 (30%) had provoked UEDVT due to oral contraceptives, CVC and lupus nephritis. 6 (60%) patients received concurrent vascular intervention such as venoplasty or thrombectomy with CDT. 4 (60%) proceeded with cervical rib excision based on MRI findings. All patients commenced treatment dose low molecular weight heparin post CDT. VTE recurred in 3 (30%) patients.

No bleeding was reported with CDT monotherapy, however one patient (10%) developed haematoma and haemothorax after combined CDT, venoplasty and rib excision. Median admission length was 6 days, with median follow up of 18 months. 2 (20%) patients were lost to follow up.

Conclusion(s): CDT is associated with low rate of VTE recurrence and bleeding. Our study has highlighted that this is a complex group of patients with a need for more robust data comparing the efficacy and safety of CDT with anticoagulation and if it has any long term benefit on reduction of post thrombotic syndrome.