A 58 years old patient, male, presented left upper limb swelling for two days, one and a half years after chemotherapeutical treatment of gastric tumor. Physical examination results: No cervical lymph node swelling was found on both sides; left side neck was swollen; left upper limb was swollen with circumference 32 cmand31 cmat8 cmabove and below the left elbow, respectively; the circumference above and below the right elbow was28 cm. No touch pain was found and blood supply showed normal on the left upper limb. Laboratory examination results: For blood test, WBC was 4.8 × 109/l, blood platelets 113 × 109/l; four blood coagulation indexes were normal; ultrasound B scan showed thrombosis formation at the left jugular vein and left subclavian vein. After admission a local anesthesia was applied to the patient and a3 cmskin incision was made at the left elbow level. The basilic vein was located and a central venous catheter was inserted and implanted. An injection of contrast media was carried out to confirm the thrombosis formation from left axillary vein. A 1.5 meter long super smooth guide wire was inserted into the superior vena cava, followed with a multi-functional catheter. A dose of 18 mg diluted recombinant human tissue-type plasminogen derivatives was injected at the subclavian vein and the internal jugular vein, respectively. After an angiography at the distal site of vein thrombotic showed re-open at the left subclavian vein and the internal jugular vein, the catheter was removed and the incision at the basilic vein was sutured. In the ward the patient was followed with anticoagulant and antiplatelet adhesion treatments. After two days, the swelling of the patient’s left upper limb was significantly reduced.
G. H. Lyman, A. A. Khorana, A. Falanga, et a1. American soci- ety of clinical oncology guideline: Recommendation for venous thromboembolism prophylaxis and treatment in patients with cancer. Journal of Clinical Oncology, 2007, 25: 5490-5505.