Evolving strategies for the management of venous thoracic outlet syndrome

We report our evolving experience with the treatment of acute VTOS.MethodsWe reviewed our prospectively maintained database to identify patients treated for VTOS. Our strategy includes CDT with pharmacomechanical thrombectomy, IC first rib resection during the same hospitalization, and subclavian vein angioplasty immediately after rib resection. Postoperatively, a sequential compression device was applied to the affected arm and low-dose heparin given through the ipsilateral venous sheath. Antiplatelet therapy was given for 6 weeks and anticoagulation for 6 months. Our strategy evolved from a PC to an IC approach, given that the added morbidity of the supraclavicular approach to allow excision of the posterior portion of the rib may add no benefit with VTOS compared with arterial or neurogenic thoracic outlet syndrome.ResultsThere were 51 patients who underwent first rib resection for VTOS, 11 (22%) through a PC approach and 40 (78%) through an IC approach. The average age was 36 years (range, 16-63 years), and the majority were female (36 [71%]) and involved the right subclavian vein (36 [71%]). All patients underwent preoperative CDT, 40 (78%) at our hospital and 11 (22%) elsewhere. Fifty patients (98%) underwent subclavian vein angioplasty after rib resection. A bare-metal stent was placed in two (4%) patients for persistent stenosis. Average length of stay was 3.7 (±2.1) days. Average operative time was 2.2 hours (range, 1.5-3.0 hours)...
Source: Journal of Vascular Surgery: Venous and Lymphatic Disorders - Category: Surgery Source Type: research

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CONCLUSIONS TOS can be evaluated by CE-MRA, T2-STIR-SPACE, and VIBE during a single examination, with a reduced contrast material dose. This imaging modality performs well in showing the anatomical structure of the neurovascular bundle and the cause of the compression. PMID: 31600179 [PubMed - in process]
Source: Medical Science Monitor - Category: Research Tags: Med Sci Monit Source Type: research
Authors: Goeteyn J, Pesser N, van Nuenen B, van Sambeek M, Teijink J Abstract Introduction: Neurogenic Thoracic Outlet Syndrome (NTOS) is caused by compression of the brachial plexus. The clinical presentation of NTOS is characterized by symptoms of pain, paresthesia, numbness or muscle weakness in the neck, arm or hand. Methods: In this case report, five patients were diagnosed with NTOS. They all had a first degree relative with NTOS as well. Conlusions: These cases show familial predisposition in thoracic outlet syndrome. Could a form of familial TOS exist? PMID: 31587610 [PubMed - as supplied by publisher]
Source: Acta Chirurgica Belgica - Category: Surgery Tags: Acta Chir Belg Source Type: research
To determine if surgical decompression for vascular thoracic outlet syndrome (TOS) outweighs the risks.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Abstracts from the 2019 Canadian Society for Vascular Surgery Annual Meeting Source Type: research
Rib resection in venous thoracic outlet syndrome (VTOS) may be approached via a transaxillary, supraclavicular, or infraclavicular approach based on surgeon preference. The purpose of this study was to evaluate long-term postoperative quality of life function after surgery for VTOS and to determine if there were long term patency differences associated with the surgical approach or whether prophylactic post-operative venography was performed
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Clinical Research, Basic Science Source Type: research
Rib resection in venous thoracic outlet syndrome (vTOS) may be approached via a transaxillary, supraclavicular, or infraclavicular approach based on surgeon preference. The purpose of this study was to evaluate long-term postoperative quality of life function after surgery for vTOS and to determine if there were long-term patency differences associated with the surgical approach or whether prophylactic postoperative venography was performed.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Clinical Research Source Type: research
No validated scales exist specifically for measuring quality of life (QoL) and functioning level in patients with thoracic outlet syndrome (TOS). This cross-sectional survey examined whether some items adopted from validated QoL scales could be suitable for patients with TOS.
Source: Journal of Shoulder and Elbow Surgery - Category: Orthopaedics Authors: Source Type: research
The optimal surgical approach and treatment algorithm for thoracic outlet syndrome (TOS) remain controversial. We sought to examine the outcomes of patients treated at a military medical treatment facility (MTF) for TOS.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Clinical Research, Basic Science Source Type: research
The optimal surgical approach and treatment algorithm for thoracic outlet syndrome (TOS) remain controversial. We sought to examine the outcomes of patients treated at a military medical treatment facility (MTF) for TOS.
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Clinical Research Source Type: research
Neurogenic thoracic outlet syndrome (TOS) is no longer either controversial or disputed, but its optimal surgical management remains unclear. Most thoracic outlet decompression procedures are carried out by first rib resection, usually through a transaxillary route.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Abstract from the 2019 Western Vascular Society Annual Meeting Source Type: research
The objective of this study was to assess the use and consequences of upper extremity duplex ultrasound (U/S) in the initial diagnostic evaluation of patients with suspected subclavian vein (SCV) thrombosis and venous thoracic outlet syndrome (VTOS).
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Abstract from the 2019 Midwestern Vascular Surgical Society Annual Meeting Source Type: research
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