Vascular thoracic outlet syndrome

The objective of this paper is to discuss the classification, diagnosis and management of vascular arterial thoracic outlet syndrome (aTOS) and venous TOS (vTOS).These can be difficult to diagnose because there is not only one standardized objective test that can be used. Treatment options continue to be conservative (uncomplicated vascular findings for vTOS) or invasive (symptomatic patient, aneurysm, intimal damage for aTOS). A transaxillary approach with rib resection offers complete exposure of the subclavian artery and vein as well as muscular and fibrous abnormalities. The method of choice for the treatment of acute vein thrombosis caused by TOS is transcatheter thrombolytic therapy followed by early surgical decompression. Complications after decompression with complete resection of the rib(s) are extremely rare. Of 124 operated patients (2007-2011) the female gender was slightly more common. The average age was 32.4 years (range 16-64 years). The clinical symptoms were neurological in 70 % and vascular in 30 % and 24 patients (19 %) were surgically treated (aTOS, includes 5 patients with aneurysms). An isolated venous complication appeared in 11 % (14 patients) and from these 14 patients 10 had acute thrombosis and 4 a post-thrombotic event, 2 of them with a pulmonary embolism disease in the medical history. Local reocclusion was observed in only one of treated patients with vTOS and seven patients were treated for complications after stent placement.