Percutaneous Transluminal Venous Angioplasty for Neurogenic Thoracic Outlet Syndrome

To characterize the effects of percutaneous transluminal venous angioplasty (PTVA) on relieving the symptoms of neurogenic thoracic outlet syndrome (nTOS).

Charts of 1,194 consecutive nTOS patients from 2010 to 2019 were analyzed. A total of 887 patients found adequate relief with conservative physical therapy, whereas 307 patients failed physical therapy and underwent diagnostic venography. Of these 307 patients, 291 (mean age 51 years, 72% female, 28% male) were found to have significant venous stenosis and were treated with PTVA. The mean follow-up period for all subjects was 19 ± 27 months (median = 13 months).

Following PTVA, 173 (59%) reported initial symptomatic improvement, 60 (21%) no change, 52 (18%) worsened symptoms, and 6 (2%) were lost to follow-up. Furthermore, of the total 291 PTVA patients, 143 (49%) required no subsequent treatment, 48 (17%) had additional endovascular PTVA intervention, 93 (32%) eventually underwent open surgery, and 6 (2%) were lost to follow-up. Complications were seen in only one patient (0.3%) who had brief asymptomatic ventricular tachycardia in the recovery room. Overall, of the 285 patients treated with PTVA, 198 (69%) avoided open surgery.

PTVA appears to be safe and effective treatment for nTOS. PTVA reduced the need for open surgical decompression in over two-thirds of patients, and thus should be considered before surgical intervention.