Modernizing the treatment of venous thoracic outlet syndrome.
This study aims to quantify the management and outcomes of patients treated for venous thoracic outlet syndrome (vTOS) over a seven-year period. A retrospective case-note review of all patients undergoing first rib resection at a regional vascular unit between January 1, 2002 and December 31, 2009 was performed. Treatment pathways and outcomes recorded as freedom from symptoms and venous patency were analyzed. Thirty-five patients were identified with vTOS. Ninety-one percent of patients had patent veins at discharge from clinical follow-up and were symptom-free at a median of 44 months. Patients treated within seven days of symptoms (94.7 versus 85.7, P = 0.060), with catheter-directed thrombolysis (94 versus 87.5% P = 0.702) and excision of first rib in less than 30 days (100 versus 85.7%, P = 0.002), had improved symptom-free rates. In conclusion, early referral, immediate catheter-directed thrombolysis, perioperative balloon venoplasty and early thoracic outlet decompression may provide a suitable model for improving outcomes in vTOS.
St George's Vascular Institute, London,  UK.
Richard F
RF
Bamford
Peter J E
PJ
Holt
Robert J
RJ
Hinchliffe
Matt M
MM
Thompson
Ian M
IM
Loftus
D000328:Adult; D000368:Aged; D000465:Algorithms; D000800:Angioplasty, Balloon; D000925:Anticoagulants / Q000627:therapeutic use; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012272:Ribs / Q000601:surgery; D013350:Subclavian Vein / Q000601:surgery; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D055815:Young Adult
D000925:Anticoagulants