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Vascular Thoracic Outlet Syndrome.

Jeffrey S. Weiss1, Joelle M. Coletta, Lee D. Hall

  • 1Department of General Surgery, Divisions of Vascular Surgery and Interventional Radiology, Naval Medical Center, San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA. coletta@pol.net

Current Treatment Options in Cardiovascular Medicine
|May 11, 2002
PubMed
Summary

Vascular thoracic outlet syndrome (TOS) requires aggressive treatment. A multimodal approach combining thrombolysis, anticoagulation, surgery, and interventions improves outcomes for TOS patients.

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Area of Science:

  • Vascular Surgery
  • Interventional Radiology
  • Hematology

Background:

  • Vascular thoracic outlet syndrome (TOS) predominantly affects young, active individuals.
  • Diagnosis relies on clinical suspicion, confirmed by imaging like venography.
  • Conservative treatments often lead to poor long-term outcomes and disability.

Purpose of the Study:

  • To evaluate a multimodal treatment protocol for vascular thoracic outlet syndrome.
  • To assess the efficacy of combined thrombolysis, anticoagulation, surgical decompression, and interventional procedures.

Main Methods:

  • Initiation of catheter-directed recombinant tissue-type plasminogen activator and intravenous heparin upon diagnosis.
  • Surgical decompression via first rib resection during the same hospitalization.

Related Experiment Videos

  • Postoperative venography to assess residual stenosis, managed with angioplasty or stent placement.

    • Main Results:

    • The multimodal protocol aims to achieve recanalization and prevent thrombus propagation.
    • Surgical decompression is feasible during the initial hospitalization.
    • Percutaneous interventions effectively manage residual stenoses, often requiring stenting.

    Conclusions:

    • A synergistic effect is observed when combining thrombolysis, anticoagulation, surgical decompression, and percutaneous interventions.
    • This multimodal strategy enhances therapeutic results in vascular thoracic outlet syndrome patients.