Vascular TOS-Creating a Protocol and Sticking to It.

Area of Science:

• Vascular Surgery
• Thoracic Surgery
• Interventional Radiology

Background:

• Thoracic Outlet Syndrome (TOS) involves neurovascular compression in the thoracic outlet.
• TOS presents as neurogenic, venous (VTOS), or arterial (ATOS) subtypes.
• Effective management strategies are crucial for improving patient outcomes.

Purpose of the Study:

• To detail the current clinical practice for managing venous and arterial TOS at a high-volume institution.
• To provide a comprehensive overview of diagnostic and therapeutic approaches.
• To establish a standardized treatment protocol for TOS subtypes.

Main Methods:

• VTOS: Acute DVT cases (<2 weeks) treated with anticoagulation, venography, and thrombolysis. Later presentations involve transaxillary first rib resection and venoplasty.
• ATOS: Acute limb ischemia managed with thrombolysis/thrombectomy, followed by staged rib resection and arterial reconstruction. Claudication cases undergo duplex/CT angiography for targeted repair.
• All patients receive appropriate anticoagulation and post-procedure monitoring.

Main Results:

• The described protocols aim to address acute and chronic presentations of VTOS and ATOS effectively.
• Transaxillary first rib resection is a key component in both venous and arterial TOS surgical management.
• Staged procedures ensure comprehensive treatment for complex vascular TOS cases.

Conclusions:

• This institutional practice provides a structured approach to managing venous and arterial TOS.
• Timely intervention and tailored treatment strategies are essential for successful TOS management.
• The outlined methods represent a robust framework for addressing TOS complications.