Multiple treatment algorithms for successful outcomes in venous thoracic outlet syndrome

León, Ricardo A. de; Chang, David C.; Hassoun, Heitham T.; Black, James H.; Roseborough, Glen S.; Perler, Bruce A.; Rotellini-Coltvet, Lisa; Call, Diana; Busse, Christopher; Freischlag, Julie A.

doi:10.1016/j.surg.2008.09.017

Cited by 77 publications

(39 citation statements)

References 10 publications

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“…As reported by de Leon et al, many such patients with chronically occluded axillo-subclavian veins will recanalize while on anticoagulation, with resolution of their respective symptoms over time. 2 Despite this posture toward chronically impaired patients, this study demonstrates that a majority of patients who present acutely with symptoms causing impairment will benefit from aggressive therapy.…”

Section: Discussionmentioning

confidence: 86%

“…Many remain unenthusiastic about placing stents in the venous system, noting a perceived inflammatory reaction, which may limit durability. 2,7 Indeed, the use of catheter-based therapies as an adjunct to surgical decompression therapy has been controversial, especially among earlier reports. Green et al, among others, have speculated that stent placement could stimulate a hyperplastic response, thereby leading to re-thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…Early management strategies featuring conservative treatment, including extremity elevation, warm compresses, and anticoagulation, were supplanted by therapeutic protocols currently involving antecedent thrombolytic therapy followed by staged surgical thoracic outlet decompression. 1,2 More recently, attempts to further refine combined endovascular and surgical treatment approaches have been the subject of many reports, with various authors espousing the merits and pitfalls of their preferred respective algorithms. 1,3–5 By comparison, little attention has been devoted to the natural history and long-term functional outcomes of such patients following invasive therapies.…”

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confidence: 99%

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Aggressive treatment of idiopathic axillo-subclavian vein thrombosis provides excellent long-term function

Stone

Scali

Bjerk

et al. 2010

Journal of Vascular Surgery

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Objective While much attention has been devoted toward treatment paradigms for idiopathic axillo-subclavian vein thrombosis (ASVT), little has focused on long-term durability of aggressive treatment and its associated functional outcomes. The purpose of this study was to review our own surgical therapeutic algorithm and its associated durability and functional outcomes. Methods All patients treated with combined endovascular and open surgery at Dartmouth-Hitchcock Medical Center for ASVT from 1988 to 2008 were identified. Patient demographics, comorbidities, and operative techniques were recorded. Patency, freedom from reintervention, and functional outcomes were documented. Follow-up via telephone and clinic visit allowed quantitative comparison of functional status, pre- and postoperatively. Results Thirty-six patients were treated for ASVT throughout the study interval. Seven patients (19.4%) were lost to follow-up. Most patients were male (66%; N = 24); mean age was 32 years. Catheter-directed thrombolysis was utilized in the majority of patients (83.3%; N = 30) with an average time from symptom onset to lysis of 12 days. Surgical decompression was undertaken in all patients via transaxillary (52%; N = 19), supraclavicular (31%; N = 11), or infraclavicular approaches (17%; N = 6). Eleven stents were placed in 11 patients (30.5%) for residual stenotic disease. Mean follow-up was 65 months, with 1- and 5-year overall patency at 100% and 94%, respectively. Freedom from reintervention was 100% and 74.4% at 1 and 5 years, respectively. Seven patients (19.4%) required postoperative reintervention with four receiving additional lytic therapy, two requiring a stent, and one venoplasty. At presentation, 65.5% (N = 19) of patients were unable to work or perform routine activities. After treatment, 86% (N = 25) returned to their employment and have experienced sustained symptomatic and functional improvement. Conclusions Patients with symptomatic idiopathic axillo-subclavian vein thrombosis can expect durable patency with sustained freedom from reintervention following aggressive combined endovascular and surgical treatment. Good functional outcomes can be expected in patients with relief of symptoms and return to work.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Aggressive treatment of idiopathic axillo-subclavian vein thrombosis provides excellent long-term function

Stone

Scali

Bjerk

et al. 2010

Journal of Vascular Surgery

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“…Consequently, we were able to recently report multiple treatment algorithms for venous TOS with regard to variable utilization of thombolysis, endovascular intervention, and different timing of operative decompression via FRRS, and found excellent axillosubclavian vein patency rates. 11 The purpose of the present study was to retrospectively review this extensive experience with venous TOS and compare the effectiveness of preoperative endovascular intervention with thrombolysis and venoplasty with anticoagulation alone in those undergoing FRRS to preserve axillosubclavian patency.…”

mentioning

confidence: 99%

Preoperative thrombolysis and venoplasty affords no benefit in patency following first rib resection and scalenectomy for subacute and chronic subclavian vein thrombosis

Guzzo

Chang

Demos

et al. 2010

Journal of Vascular Surgery

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Preoperative endovascular intervention offered no benefit over simple anticoagulation prior to FRRS, since the use of thrombolysis prior to FRRS, regardless of need for postoperative venoplasty, had little impact on overall rates of patency. The optimal treatment algorithm may merely be routine anticoagulation for all effort thrombosis patients prior to FRRS followed by venography with venoplasty if needed. The role of thrombolysis for Paget-Schroetter syndrome should be further investigated in randomized trials.

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“…All of these patients were treated with anticoagulation during the postoperative period and found to have recanalization of their subclavian veins on average 7 months after surgery. On the basis of these findings, we recommend that all patients presenting with symptoms secondary to chronic venous TOS undergo a standard treatment algorithm consisting of FRRS followed by anticoagulation and follow-up venograms until evidence of subclavian vein patency occurs [18 ].…”

Section: Venous Thoracic Outlet Syndromementioning

confidence: 99%

Contemporary management of thoracic outlet syndrome

Brooke

Freischlag

2010

Current Opinion in Cardiology

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Multiple treatment algorithms for successful outcomes in venous thoracic outlet syndrome

Cited by 77 publications

References 10 publications

Aggressive treatment of idiopathic axillo-subclavian vein thrombosis provides excellent long-term function

Aggressive treatment of idiopathic axillo-subclavian vein thrombosis provides excellent long-term function

Preoperative thrombolysis and venoplasty affords no benefit in patency following first rib resection and scalenectomy for subacute and chronic subclavian vein thrombosis

Contemporary management of thoracic outlet syndrome

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