Abstract
IntroductionSurgical management of Venous Thoracic Outlet Syndrome (vTOS) is based upon resection of the first rib. The optimal method to treat any residual venous scarring however remains unclear. The purpose of this study was to evaluate a single quaternary centre’s early and mid-term outcomes following endovascular reconstruction of the axillo-subclavian vein using dedicated venous stents in patients with VTOS.MethodologyA retrospective analysis of patients at Royal Prince Alfred Hospital, who underwent upper limb deep venous stenting as an adjunct in the treatment of vTOS was performed. All patients between 2012 and 2017 were included. Stent patency was assessed with duplex ultrasonography. All re-interventions and their indications were recorded.ResultsA total of 24 limbs in 21 patients (13 female, median age 44 yrs) were treated with dedicated venous stents between 2012 and 2017. All patients had resection of their first rib using a transaxillary approach. Nine patients initially presented with an acute DVT and underwent thrombolysis. In three of these patients a venous stent was placed before rib resection following completion of lysis. In the remainder, the median time for stent placement following surgery was 64 days. Median follow-up from stent insertion was 50 months. Primary, primary-assisted and secondary patency at 24 months was 55%, 95% and 100% respectively with one patient lost during follow-up. There were no major complications. A total of 14 re-interventions were performed on these patients. Three patients reported residual symptoms following stenting including heaviness (n = 1), bluish discolouration (n = 1) and prominent veins on the chest (n = 1) with the remainder asymptomatic.ConclusionIn this single centre study, endovascular reconstruction using dedicated venous stents appears to be an effective and safe method to reconstruct a damaged subclavian vein following rib resection in patients with vTOS.
Highlights
Surgical management of Venous Thoracic Outlet Syndrome is based upon resection of the first rib
Venous thoracic outlet syndrome occurs due to an anatomical narrowing of the costoclavicular triangle through which the axillo-subclavian vein passes. One variant of this condition is Paget–Schroetter syndrome (PSS) or effort- induced thrombosis of the subclavian vein which has an incidence of 1–2/100,000 people and was first
All patients are commenced on a heparin infusion and if the patient has an appropriate risk-benefit profile and symptom onset suggestive of venous thrombosis within 2 weeks of presentation, we offer Catheter directed thrombolysis (CDT)
Summary
Surgical management of Venous Thoracic Outlet Syndrome (vTOS) is based upon resection of the first rib. Venous thoracic outlet syndrome (vTOS) occurs due to an anatomical narrowing of the costoclavicular triangle through which the axillo-subclavian vein passes. One variant of this condition is Paget–Schroetter syndrome (PSS) or effort- induced thrombosis of the subclavian vein which has an incidence of 1–2/100,000 people and was first. The purpose of this study was to evaluate a single quaternary centre’s early and mid-term outcomes following endovascular reconstruction of the axillo-subclavian vein using dedicated venous stents in patients with VTOS
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