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A Journal on Phlebology
Acta Phlebologica 2010 April;11(1):11-6
Upper-extremity deep vein thrombosis among women who have been operated for breast cancer
Baroncelli T., Bulli F., Miccinesi G., Muraca M. G.
ISPO Villa delle Rose, Florence, Italy
AIM: Upper-extremity deep vein thrombosis is a quite rare pathology. A large part of upper-extremity deep vein thromboses is linked to cancer. Today there is no publication of studies which focused on the characteristics of the venous thrombosis among patients with upper-extremity lymphedema after breast cancer. The aims of this study were: 1) to evaluate the incidence of venous thrombosis in patients with upper extremity lymphedema in an oncological rehabilitation setting; 2) to describe the method of diagnosis and to give indications for a therapeutic strategy fit for the treatment of venous thrombosis and also for the treatment of the concomitant lymphedema.
METHODS: the study enrolled 1349 consecutive female patients with breast cancer who accessed the Center for oncological rehabilitation in Florence between 2006-2007. Among them, 696 patients started an oncological rehabilitation program and 653, already under treatment, have taken part at least once at the rehabilitation service; 162 women among the new patients (162/696=23.2%) and 325 among the patients in the follow-up phase (325/653=49.8%) had lymphedema. Two-hundreds and thirty-one out of the 487 patients with lymphedema were sent for an angiologist’s consultation and echography of the arm, in order to evaluate the severity and the evolution of the lymphedema (132 patients), or for suspected thrombosis (99 patients). They were overhauled with echo-color-Doppler.
RESULTS: The incidence of venous thrombosis of the upper extremity limb on the total of the patients taking part in the oncological rehabilitation in the period between 2006-2007 was 3.5% (46/1349); considering only the patients with lymphedema the percentage raised to 9.4% (46/487). For 46 (46,5%) of the 99 patients with suspected thrombosis the diagnosis of venous thrombosis in the upper extremity limb was confirmed. They had been submitted to chemiotherapy treatment (69.6% vs. 45.3%; P=0.015), had shorter interval since the diagnosis of the lymphedema (0.4 vs. 0.8 year; P=0.043), and in more than a half of the cases (51.2%) they had a breast tumor larger than 2 cm (38.6% in the group of patients without venous thrombosis, P=0.066). Lastly, the number of lymphnods affected by the neoplastic diffusion resulted higher (73.8% vs. 53.5%; P=0.052). The treatment had a positive result of recanalization in more than 90% of the cases. Such result was reached, in average, in a little longer than a month.
CONCLUSION: These first results show the need of an angiology expert in the multidisciplinary team dealing with the rehabilitation of women with breast cancer. Furthermore, it could be useful to suggest some specific indications for the diagnosis of upper-extremity deep vein thrombosis in patients with lymphedema to improve the GIUV guidelines.