Axillosubclavian Vein Thrombectomy, Thrombolysis, and Angioplasty

Ahn, Samuel S.; Conley, Milton; Ahn, JoongHo

doi:10.1016/b978-1-4160-6208-0.10065-5

Cited by 1 publication

(2 citation statements)

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“…Males and laborers performing strenuous work are predominantly concerned whereas women suffer from neurogenic TOS to a greater extent. The right upper extremity is affected more often presumably because of the prevalence of dexterity in mankind irrespective of the etiology of TOS [1]. In our series, the number of right sided interventions reached as much as 19 cases (73%).…”

Section: Paget-schroetter Diseasementioning

confidence: 52%

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Robotic-Assisted Thoracoscopic Resection of the First Rib for Vascular Thoracic Outlet Syndrome: The New Gold Standard of Treatment?

Zehnder

Lutz

Dorn

et al. 2021

JCM

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In thoracic outlet syndrome (TOS) the narrowing between bony and muscular structures in the region of the thoracic outlet/inlet results in compression of the neurovascular bundle to the upper extremity. Venous compression, resulting in TOS (vTOS) is much more common than a stenosis of the subclavian artery (aTOS) with or without an aneurysm. Traditional open surgical approaches to remove the first rib usually lack good exposure of the entire rib and the neurovascular bundle. Between January 2015 and July 2021, 24 consecutive first rib resections for venous or arterial TOS were performed in 23 patients at our institutions. For our completely portal approach we used two 8mm working ports and one 12/8 mm camera port. Preoperatively, pressurized catheter-based thrombolysis (AngioJet®) was successfully performed in 13 patients with vTOS. Operative time ranged from 71–270 min (median 128.5 min, SD +/− 43.2 min) with no related complications. The chest tube was removed on Day 1 in all patients and the hospital stay after surgery ranged from 1 to 7 days (median 2 days, SD +/− 2.1 days). Stent grafting was performed 5–35 days (mean 14.8 days, SD +/− 11.1) postoperatively in 6 patients. The robotic approach to first rib resection described here allows perfect exposure of the entire rib as well as the neurovascular bundle and is one of the least invasive surgical approaches to date. It helps improve patient outcomes by reducing perioperative morbidity and is a procedure that can be easily adopted by trained robotic thoracic surgeons. In particular, patients with a/vTOS may benefit from careful and meticulous preparation and removal of scar tissue around the vessels.

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Section: Paget-schroetter Diseasementioning

confidence: 52%

“…Some patients also suffer from congenital bands and fibrous slips interdigitating with neurovascular structures. This fact elucidates why mechanical compression is the principal cause of symptoms [1]. We differentiate between neurogenic, non-specific, venous and arterial TOS.…”

Section: Introductionmentioning

confidence: 75%