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Deep vein thrombosis (DVT) of the upper limbs represents 1-4% of DVT, most of them related to central venous catheter and / or malignancy. Thrombosis involving the deep veins (ie, subclavian, axillary, brachial) can lead to complications as pulmonary embolism (PE) and long-term sequelae. PE from upper extremity sources accounts for about 6 % of cases. Initial treatment in acute context include fibrinolysis and subsequent anticoagulation (Grade 2C). When symptomatology is mild and/or onset of symptoms undetermined (> 2 weeks), minimum anticoagulation 3 months is recommended. If there are associated anatomical abnormalities, the possibility of surgical vascular thoracic decompression must be assessed.

A retrospective audit was undertaken to determine the aetiology and clinical presentation on patients which UDVT at presentations. Patients wich a formal malignacy confirmed before the diagnosis was excluded. A D dimer (DD) with a cutt off cut off levels validated for lower limb DVT was performed.

A total of 18 patients was identify in the period of 2012 to 2016. All the cases investigations included Doppler US or CT/MRI and in 30% of the patients the thrombosis was confirmed via contrast venography as a reference standard test. The gender predominan was male in this group the symptomatology were related to physical efforts in a 60 % (Paget-Shroëtter Syndrome) whereas in female serie the predominant was thrombophilic defects (factor V Leiden). The average age was 33 years (ranging from 21 to 68 years) and 2 elderly patients a new diagnosis of cancer was confirmed (thyroid and lung) (odds ratio, 3.24; 95% CI, 1.13-9.38).

The 85% of the patients had an unprovoked event; four patients have a diagnosis of catheter related thrombosis and four cases a thrombofilic defect (factor V Leiden) precipated by anticonceptive. Two patients had a diagnosis of SLE. We had four cases of positve DD screening (both were marginally elevated, P < 0.01) . The risk of re-thrombosis was non significative but in the subanalysis of relapsing thrombotic event populations the risk of relapse increased proportionally in relation of thrombofilic defect and high BMI. A trend towards a higher rate of recurrent thrombosis (was observed among patients with BMI> 25 (42.6%) compared to those with a BMI <25 (33%). This difference reached statistical significance in women with BMI> 25, who had recurrent event in 51.7% of the cases vs. those with BMI <25 (29.7%) (p <0.05 CI 0.03, 0.41).

In the unprovoke serie the relation of DD was positive in less tan 30% of the cases and non stadistically significative (p <0.01). In the case of subclavian vein oclusion this is result in limited clot burden (which explain the correspondence with negative DD value)

The risk of re-thrombosis is asociated with thrombophilic defect and high BMI esclusively.

The DD adjusted to age and specific young population need to be adressed (age adjusted DD cut off adpated of the specific population)

A prospective studies of DD in suspected UDVT need to be adressed.