title: Vascular thoracic outlet syndrome: successful outcomes with multimodal therapy.
abstract: OBJECTIVE
  Vascular thoracic outlet syndrome (TOS) can present with signs of arterial impingement or, more commonly, as venous obstruction. In an effort to decrease morbidity associated with vascular thoracic outlet syndrome, we have used an aggressive multimodal treatment approach.
  
  
  METHODS
  Since November 1992, we have evaluated 29 patients with vascular thoracic outlet syndrome. Nine of ten patients with arterial thoracic outlet syndrome had first rib resections. Eighteen of 19 patients with venous occlusion underwent anticoagulation, thrombolysis, and first rib resection. Eight patients required additional endovascular therapy for persistent stenoses, either venous angioplasty alone (2) or angioplasty plus stent placement (6).
  
  
  RESULTS
  Follow up extends to 75months with a mean of 24months. Patients with stents have been followed for a mean of 38months. Twenty-five of 28 patients managed with multimodal therapy were essentially asymptomatic at last follow up.
  
  
  CONCLUSIONS
  Thrombolysis, anticoagulation, surgical decompression, and endovascular procedures act synergistically to improve results of therapy in patients with vascular thoracic outlet syndrome.
authors.affiliation: Divisions of Vascular Surgery and Interventional Radiology and the Department of Clinical Investigation, Naval Medical Center San Diego, CA, San Diego, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Coletta
authors.forename: J D
authors.initials: JD
authors.lastname: Murray
authors.forename: T R
authors.initials: TR
authors.lastname: Reeves
authors.forename: T E
authors.initials: TE
authors.lastname: Velling
authors.forename: F J
authors.initials: FJ
authors.lastname: Brennan
authors.forename: J R
authors.initials: JR
authors.lastname: Hemp
authors.forename: L D
authors.initials: LD
authors.lastname: Hall
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012074:Remission Induction; D012189:Retrospective Studies; D013901:Thoracic Outlet Syndrome / Q000628:therapy*; D016896:Treatment Outcome