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Axillary Vein Thrombosis (AVT) and Breast Cancer
Axillary vein thrombosis (AVT) in patients with breast cancer and arm lymphedema is often overlook probably because the clinician does not suspect this condition exists.
Cases reported in the medical literature ranges as an initial manifestation of an inflammatory breast cancer, after axillary lymph nodes dissection and after radiotherapy.
One of the issues with AVT is that can present insidiously, making more difficult to be diagnosed.
In my clinical experience, I suspect this condition may be present when you have a rapid onset arm lymphedema, arm lymphedema that has been stable and worsen without any obvious triggering factors; or even an arm lymphedema that is responding very slowly to treatment with or without associated pain.
Early diagnosis and treatment is extremely important because adequate management improves prognosis and response to treatment.
Diagnosis is made with a venous ultrasound doppler of the upper extremities. On physical examination an axillary cord can be visible and/or engorgement of proximal – chest superficial veins.
I have seen patients not only with AVT, but thrombus extending to the subclavian vein and distally to the basilic vein.
Anticoagulation with low-molecular-weight heparin and warfarin as per lower limb deep venous thrombosis (DVT) is the mainstay of management. Sufficient analgesia should be prescribed. Elevation of the arm can help.
Questioning about when to start MLD/CDT? Based on my clinical experience, if pain is present should be subsiding as well as some of the edema, anticoagulation levels should be achieved and confirmed by two consecutive PT(prothrombin time)/INR(international normalized ratio) between 2 – 3. Use of pneumatic compression devices are contraindicated.
References:
Ann R Coll Surg Engl. 2012 Mar;94(2):55-6
Clin Radiol.1987 Jan;38(1):95-6.
Expert Rev Anticancer Ther. 2006 Nov;6(11):1629-38.
Author: Margarita Correa MD
www.lymphedemaphysmedi.com
Cases reported in the medical literature ranges as an initial manifestation of an inflammatory breast cancer, after axillary lymph nodes dissection and after radiotherapy.
One of the issues with AVT is that can present insidiously, making more difficult to be diagnosed.
In my clinical experience, I suspect this condition may be present when you have a rapid onset arm lymphedema, arm lymphedema that has been stable and worsen without any obvious triggering factors; or even an arm lymphedema that is responding very slowly to treatment with or without associated pain.
Early diagnosis and treatment is extremely important because adequate management improves prognosis and response to treatment.
Diagnosis is made with a venous ultrasound doppler of the upper extremities. On physical examination an axillary cord can be visible and/or engorgement of proximal – chest superficial veins.
I have seen patients not only with AVT, but thrombus extending to the subclavian vein and distally to the basilic vein.
Anticoagulation with low-molecular-weight heparin and warfarin as per lower limb deep venous thrombosis (DVT) is the mainstay of management. Sufficient analgesia should be prescribed. Elevation of the arm can help.
Questioning about when to start MLD/CDT? Based on my clinical experience, if pain is present should be subsiding as well as some of the edema, anticoagulation levels should be achieved and confirmed by two consecutive PT(prothrombin time)/INR(international normalized ratio) between 2 – 3. Use of pneumatic compression devices are contraindicated.
References:
Ann R Coll Surg Engl. 2012 Mar;94(2):55-6
Clin Radiol.1987 Jan;38(1):95-6.
Expert Rev Anticancer Ther. 2006 Nov;6(11):1629-38.
Author: Margarita Correa MD
www.lymphedemaphysmedi.com
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