Venous Thoracic Outlet Syndrome (vTOS): May Surgery be a Solution in Chronic Form?

Area of Science:

• Vascular Surgery
• Thoracic Surgery
• Interventional Radiology

Background:

• Chronic venous thoracic outlet syndrome (vTOS) involves subclavian vein compression post-deep vein thrombosis, leading to morbidity and post-thrombotic syndrome.
• Current management for chronic vTOS is not standardized, highlighting a need for effective treatment strategies.
• This study evaluates thoracic outlet decompression outcomes for chronic vTOS patients.

Purpose of the Study:

• To assess the effectiveness of thoracic outlet decompression in managing chronic vTOS.
• To provide insights into optimal management strategies for chronic vTOS based on patient stratification.
• To evaluate symptom relief and functional recovery post-surgery.

Main Methods:

• Retrospective review of 83 patients with chronic vTOS undergoing transaxillary first-rib resection (January 2013-April 2024).
• Preoperative stratification into three groups based on venous recanalization and collateral circulation.
• Assessment of postoperative outcomes including symptom resolution and imaging findings.

Main Results:

• Overall, 83% of patients experienced substantial symptom improvement, enabling cessation of anticoagulation.
• Group I (complete recanalization) achieved 89% symptom resolution; Group II (partial recanalization) saw 61% improvement with adjunctive angioplasty.
• Group III (persistent occlusion) showed improved collateral circulation and significant symptomatic relief post-decompression.

Conclusions:

• Transaxillary first-rib resection is an effective surgical intervention for symptomatic relief in chronic vTOS.
• Preoperative imaging and clinical analysis are crucial for guiding surgical decisions and predicting outcomes.
• Patient stratification can inform postoperative management, including the potential need for endovascular interventions.