Thoracic Outlet Syndrome, United Kingdom: A Retrospective Review of Practice

Thoracic outlet syndrome (TOS) is caused by compression of the neurovascular bundle at the thoracic outlet which often poses a diagnostic challenge. Patient management is often based on surgeon choice and experience. This study aims to describe practices relating to the diagnosis and management of TOS in the UK over a 1-year period.

This multicenter retrospective UK study included data from 16 vascular centers, analyzing surgical management and postoperative outcomes of patients treated for TOS in 2019. Outcomes were evaluated by TOS type: neurogenic (nTOS), venous (vTOS), or arterial TOS (aTOS).

Data on 133 patients from 16 units were collected over a 1-year period. Most patients were female (87 of 133; 65%). Surgeries addressed nTOS (53 of 133; 40%), vTOS (48 of 133; 36%), and aTOS (32 of 133; 24%), with TOS type unspecified in 2 patients. Five imaging modalities were used for diagnosis. Surgical approaches included supraclavicular (90 of 133; 68%), transaxillary (23 of 133; 17%), infraclavicular (13 of 133; 10%), paraclavicular (6 of 133; 5%), and thoracoscopic (1 of 133; <1%). Pleural injury was the most reported complication (16 of 133; 12%). Most patients with pleural injury were managed conservatively, with only one-quarter requiring the insertion of a chest drain (4 of 16; 25%). Most patients (119 of 133; 89%) had symptom resolution, lower in nTOS compared to arterial and vTOS (P < 0.05).

There is considerable variability in the diagnosis and management of patients with TOS across vascular centers in the UK. This study supports the development of a national registry and the creation of best practice guidelines in the future.