A duplex ultrasound study was obtained of the left upper extremity which revealed a superficial brachial vein thrombosis without evidence of a deep venous thrombosis. Vascular surgery was consulted and recommended no surgical intervention. The patient was instructed to apply warm compresses to his proximal forearm and to take ibuprofen as needed for pain.
Unlike a deep venous thrombosis (DVT), a superficial venous thrombosis does not require anticoagulative therapy. Patients can develop superficial venous thrombi in the upper extremities as a complication of having an arteriovenous fistula, however thrombi in the superficial venous system generally do not cause clinically significant thromboembolic disease and tend to self-resolve.
It is important to check the patient's arteriovenous fistula for a palpable and/or audible thrill to ensure it is functioning properly. Warm compresses can be applied to aid clot dissolution and NSAIDs taken for symptomatic pain.
It is important to check the patient's arteriovenous fistula for a palpable and/or audible thrill to ensure it is functioning properly. Warm compresses can be applied to aid clot dissolution and NSAIDs taken for symptomatic pain.
References:
Rosen's Emergency Medicine Concepts and Clinic Practice, 8th Ed, 2014, Chapter 88: Pulmonary Embolism and Deep Venous Thrombosis by Jeffrey A. Kline
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