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)...
Thoracic Outlet Syndrome
The supraclavicular exposure has emerged as a favorable approach for thoracic outlet decompression in nTOS. We aimed to evaluate the learning curve for supraclavicular thoracic outlet decompression and associated patient functional outcomes.
Publication date: Available online 23 September 2020Source: International Journal of Surgery Case ReportsAuthor(s): C. Curuk, H. Ohida, T. Gebauer, E. Stegemann, T. Buerger
Robotic first rib resection (R-FRR) is an emerging approach in the field of TOS that has technical advantages over traditional open approaches including superior exposure of the first rib and freedom from retracting neurovascular structures. We set out to define the safety of R-FRR and compare it with that of the conventional supraclavicular approach (SC-FRR).
Title: Thoracic Outlet Syndrome (TOS)Category: Diseases and ConditionsCreated: 12/31/1997 12:00:00 AMLast Editorial Review: 8/26/2020 12:00:00 AM
The purpose of this study was to compare pulmonary function and respiratory muscle strength and endurance in individuals with thoracic outlet syndrome (TOS) and healthy participants.
Treatment of venous thoracic outlet syndrome (vTOS) is accomplished by a combination of endovascular therapy (EVT) and first rib resection (FRR). For FRR, an open (O-FRR) or robotic-assisted transthoracic (R-FRR) approach can be performed. The R-FRR approach entails smaller incisions and offers an unmatched view of the first rib (Fig, A). The present study compared the acute and mid-term results of R-FRR vs O-FRR for vTOS.
Neurogenic thoracic outlet syndrome (TOS) is a challenging disease because of its varied and nonspecific presenting symptoms that overlap with other neurologic disorders, with often disappointing Results after surgical decompression. Our objective was to describe our thoracic outlet clinic, where a management algorithm (Fig) using a multidisciplinary approach to neurogenic TOS has been adopted, and to compare our surgical results before and after this clinic was established.
Multiple algorithms exist for treating acute primary upper extremity deep venous thrombosis (pUEDVT) caused by Venous Thoracic Outlet Syndrome (VTOS). In this case series we present the results of our dedicated same admission treatment algorithm.Design: prospective cohort study.
Thoracic outlet syndrome (TOS) refers to a constellation of compressive problems that occur at the thoracic outlet. TOS has been recognized since the 19th century, and the “modern” era of treatment, especially for neurogenic TOS, dates from at least the 1970s. Despite this, however, the incidence and prevalence of these syndromes are almost completely unknown. To attempt to answer this fundamental question, we established a prospective database of all patients who presented to our clinic with a diagnosis of potential TOS, as described below.