title: Venous Thoracic Outlet Syndrome: The Role of Early Rib Resection.
abstract: The upper extremity is an uncommon site for deep vein thrombosis and, although most of these thrombotic events are secondary to catheters or indwelling devices, venous thoracic outlet syndrome is an important cause of primary thrombosis. Young, active, otherwise healthy individuals that engage in repetitive upper extremity exercises, such as those required by a military vocation, may be at an increased risk. We present the case of a Naval Officer diagnosed with venous thoracic outlet syndrome whereby a multimodal approach with early surgical decompression was used. Although thoracic outlet decompression by means of first rib resection is the standard of care, timing of first rib resection after thrombolysis is debated. With respect to the active duty service member, the optimal timing of additional postoperative interventions for residual venous defects and duration of anticoagulation remain in question. A more streamlined perioperative treatment regimen may benefit the military patient without jeopardizing the quality of care and allow more expeditious return to full duty.
authors.affiliation: USS Somerset (LPD-25), Medical Department, Naval Base San Diego, FPO AP 96678-1709, San Diego, CA, 92113.
authors.forename: Vienna G
authors.initials: VG
authors.lastname: Katana
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Weiss
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D008889:Military Personnel; D010146:Pain / Q000209:etiology; D012272:Ribs / Q000002:abnormalities / Q000098:blood supply; D013901:Thoracic Outlet Syndrome / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D015912:Thrombolytic Therapy / Q000379:methods; D014463:Ultrasonography / Q000379:methods; D020246:Venous Thrombosis / Q000209:etiology*