Long Term Results of Surgical Treatment of Chronic Venous Thoracic Outlet Syndrome: A Single Centre Experience.

IF 8.5 1区医学 Q1 PERIPHERAL VASCULAR DISEASE

European Journal of Vascular and Endovascular Surgery Pub Date : 2026-10-16 DOI:10.1016/j.ejvs.2026.10.014

Stijn B J Teijink, Reshabh Yadav, Yves Y Dujardin, Niels Pesser, Barend M E Mees, Saskia Houterman, Jens Goeteyn, Joep A W Teijink

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引用次数: 0

Abstract

Objective: This retrospective cohort study with cross-sectional analysis aimed to evaluate the surgical and long term functional outcomes of a structured treatment algorithm for patients with chronic venous thoracic outlet syndrome (cVTOS).

Methods: Patients with cVTOS and treated at this tertiary centre between 2016 and 2024 were included. Treatment consisted of transaxillary thoracic outlet decompression (TOD), venolysis, and subclavian vein (SCV) recanalisation. In case of persistent venous obstruction during the primary procedure, anticipated repeat percutaneous transluminal angioplasty (PTA) was planned. Anticoagulation (rivaroxaban) was prescribed until 48 hours before surgery, resumed the day after surgery for six weeks, or until 48 hours before re-PTA. The primary endpoint included SCV patency and secondary outcomes included functional outcomes (DASH and Derkash scores).

Results: Seventy patients were included (mean age 35 years; 56% women). Median time to presentation was 40 (20.0 - 104.0) months after initial upper extremity deep vein thrombosis (UEDVT). Eleven patients (16%) had an operative complication (haematoma n = 6, pneumothorax n = 1, UEDVT n = 1, transient Horner syndrome n = 1, phrenic nerve injury n = 1, and SCV rupture n = 1). Median length of hospital stay was 1.0 day. Venography post-TOD/PTA showed persistent venous obstruction in 15 patients (21%) for which re-PTA was planned. Over time, 20 patients (29%) developed re-stenosis. A total of 35 (50%) re-PTAs were performed. Primary patency was 56%, primary assisted patency was 86%, and secondary patency was 93% at last follow up (12 months). Median post-operative DASH score decreased significantly (pre-op: 32.9 (15.8 - 48.3) vs. post-op 8.0 (2.3 - 27.8); p < .001) with a mean follow up of 45.7 ± 27.5 months. Zero patients reported a poor Derkash score.

Conclusion: Chronic VTOS can be effectively treated with good long term functional outcomes. Re-PTAs were necessary in half of the cases (anticipated). This treatment algorithm diminished the need of secondary interventions in 50% of the cases, as well as the need for long term anticoagulation usage.

查看原文本刊更多论文

慢性静脉胸廓出口综合征手术治疗的长期结果：单一中心经验。

目的：本回顾性队列研究采用横断面分析，旨在评估一种结构化治疗算法对慢性静脉胸廓出口综合征（cVTOS）患者的手术和长期功能结果。方法：纳入2016年至2024年在该三级中心治疗的cVTOS患者。治疗包括经腋窝胸廓出口减压（TOD）、静脉溶解和锁骨下静脉（SCV）再通。如果在初次手术中出现持续性静脉阻塞，则计划再次进行经皮腔内血管成形术（PTA）。抗凝（利伐沙班）处方直到手术前48小时，手术后第二天恢复6周，或直到重新pta前48小时。主要终点包括SCV通畅，次要终点包括功能终点（DASH和Derkash评分）。结果：纳入70例患者（平均年龄35岁，56%为女性）。上肢深静脉血栓形成（UEDVT）后至就诊的中位时间为40（20.0 - 104.0）个月。11例（16%）出现手术并发症（血肿6例，气胸1例，UEDVT 1例，短暂性Horner综合征1例，膈神经损伤1例，SCV破裂1例）。中位住院时间为1.0天。tod /PTA后静脉造影显示15例（21%）患者持续静脉阻塞，计划重新PTA。随着时间的推移，20名患者（29%）再次发生狭窄。共行35例（50%）re- pta。最后随访12个月，原发性通畅56%，原发性辅助通畅86%，继发性通畅93%。术后DASH评分中位数显著下降(术前：32.9(15.8 - 48.3)，术后8.0 (2.3 - 27.8)；P < 0.001)，平均随访45.7±27.5个月。无患者报告Derkash评分较低。结论：慢性VTOS可有效治疗，远期功能预后良好。在一半的情况下（预期），re - pta是必要的。在50%的病例中，这种治疗方法减少了二次干预的需要，以及长期抗凝使用的需要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Vascular and Endovascular Surgery 医学-外科

CiteScore

6.80

自引率

15.80%

发文量

471

审稿时长

66 days

期刊介绍： The European Journal of Vascular and Endovascular Surgery is aimed primarily at vascular surgeons dealing with patients with arterial, venous and lymphatic diseases. Contributions are included on the diagnosis, investigation and management of these vascular disorders. Papers that consider the technical aspects of vascular surgery are encouraged, and the journal includes invited state-of-the-art articles. Reflecting the increasing importance of endovascular techniques in the management of vascular diseases and the value of closer collaboration between the vascular surgeon and the vascular radiologist, the journal has now extended its scope to encompass the growing number of contributions from this exciting field. Articles describing endovascular method and their critical evaluation are included, as well as reports on the emerging technology associated with this field.