Deep Venous Thrombosis (Arm, Suspected)

Population Covered By The Guidance

This pathway provides guidance for imaging adult patients with suspected upper limb deep venous thrombosis.

Lead Researcher: Arjun Shivananda

Experts & Contributors: Ravinder Dhillon, Rachael O'Rourke

Editorial Panel: Core membership
Link to Editorial Panel

Date reviewed: September 2017

Date Published: December 2017

Image 1a, 1b and 1c (Doppler Ultrasound): Images demonstrate thrombus extending from the basilic (Images 1a and 1b) to the subclavian vein (Image 1c)

Arm Deep Venous Thrombosis

Image 1a, 1b and 1c (Doppler Ultrasound): Images demonstrate thrombus extending from the basilic (Images 1a and 1b) to the subclavian vein (Image 1c)

Arm Deep Venous Thrombosis

Image 1a, 1b and 1c (Doppler Ultrasound): Images demonstrate thrombus extending from the basilic (Images 1a and 1b) to the subclavian vein (Image 1c)

Arm Deep Venous Thrombosis

  • The incidence of Upper limb DVT has increased due to frequent insertion of intravenous devices for various indications
  • Doppler US is the imaging modality of choice for suspected upper extremity deep venous thrombosis
  • Venography is now rarely used in the assessment of possible upper limb DVT

Date of literature search: July 2017

References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document

  1. Spiezia L, Simioni P. Upper extremity deep vein thrombosis. Intern Emerg Med. 2010;5(2):103-9. (Review article). View the reference
  2. Robert-Ebadi H, Becker F, Righini M. [Upper extremity deep vein thrombosis: a particular form of venous thromboembolism]. Rev Med Suisse. 2015;11(460):342, 4-7. (Review article). View the reference
  3. Heil J, Miesbach W, Vogl T, Bechstein WO, Reinisch A. Deep Vein Thrombosis of the Upper Extremity. Dtsch Arztebl Int. 2017;114(14):244-9. (Review article). View the reference
  4. Mustafa BO, Rathbun SW, Whitsett TL, Raskob GE. Sensitivity and specificity of ultrasonography in the diagnosis of upper extremity deep vein thrombosis: a systematic review. Arch Intern Med. 2002;162(4):401-4. (Level II evidence). View the reference
  5. Baarslag HJ, van Beek EJ, Koopman MM, Reekers JA. Prospective study of color duplex ultrasonography compared with contrast venography in patients suspected of having deep venous thrombosis of the upper extremities. Ann Intern Med. 2002;136(12):865-72. (Level II evidence). View the reference
  6. Prandoni P, Polistena P, Bernardi E, Cogo A, Casara D, Verlato F, et al. Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complications. Arch Intern Med. 1997;157(1):57-62. (Level II evidence). View the reference
  7. Knudson GJ, Wiedmeyer DA, Erickson SJ, Foley WD, Lawson TL, Mewissen MW, et al. Color Doppler sonographic imaging in the assessment of upper-extremity deep venous thrombosis. AJR Am J Roentgenol. 1990;154(2):399-403. (Level IV evidence). View the reference
  8. Baxter GM, Kincaid W, Jeffrey RF, Millar GM, Porteous C, Morley P. Comparison of colour Doppler ultrasound with venography in the diagnosis of axillary and subclavian vein thrombosis. Br J Radiol. 1991;64(765):777-81. (Level II evidence). View the reference
  9. Baarslag HJ, van Beek EJ, Tijssen JG, van Delden OM, Bakker AJ, Reekers JA. Deep vein thrombosis of the upper extremity: intra- and interobserver study of digital subtraction venography. Eur Radiol. 2003;13(2):251-5. (Level II evidence). View the reference
  10. Haire WD, Lynch TG, Lund GB, Lieberman RP, Edney JA. Limitations of magnetic resonance imaging and ultrasound-directed (duplex) scanning in the diagnosis of subclavian vein thrombosis. J Vasc Surg. 1991;13(3):391-7. (Level III evidence) View the reference
  11. Joffe HV, Kucher N, Tapson VF, Goldhaber SZ. Upper-extremity deep vein thrombosis: a prospective registry of 592 patients. Circulation. 2004;110(12):1605-11. (Review article). View the reference

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Status Of Recommendations Each pathway is designed to assist clinicians in situations when faced with a large array of possible diagnostic tests and examinations. However, it is recognised that diagnostic practice may differ from a particular pathway depending on local availability of equipment and expertise, as well as the experience of individual clinicians. Therefore each pathway is neither a rigid set of rules, nor a substitute for clinical assessment, and individual patient circumstances should always be considered.

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