Multiple treatment algorithms for successful outcomes in venous thoracic outlet syndrome

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

Research output: Contribution to journalArticle

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Abstract

Background: We sought to determine the outcomes in patients presenting with venous thoracic outlet syndrome. Methods: Prospectively collected data from 67 patients between October 2003 and December 2007. The average age was 31 years (range, 16-54); the 37 males and 30 females presented on average 9.2 months (range, 1 month-6 years) after acute thrombosis. Four treatment algorithms were utilized. Results: In group 1, 3 patients presented with acute occlusion and received tissue plasminogen activator (tPA) and immediate first rib resection with scalenectomy (FRRS). One vein rethrombosed and was treated by intravenous tPA postoperatively. In group 2, 39 patients presented with stenotic subclavian veins an average of 22 weeks after their initial thrombosis, all of whom underwent FRRS followed by a venogram 2 weeks postoperatively: 25 had a tight stenosis and underwent venoplasty with anticoagulation; 13 had patent, nonstenotic subclavian veins, and 1 patient required tPA and venoplasty owing to rethrombosis. Two patients had their subclavian vein thrombose after venoplasty and were treated with anticoagulation, tPA, and venoplasty. In group 3, 11 patients presented with intermittent venous obstruction without thrombosis and underwent FRRS; 3 underwent venograms because of concerns of residual stenosis, 2 of whom required venoplasty postoperatively. Finally, in group 4, 14 patients presented with occluded subclavian veins and underwent FRRS with long-term anticoagulation. Eleven have recanalized at an average of 6 months (range, 2-12). Conclusion: Overall, 64 of 67 patients have patent subclavian veins after a median follow-up of 10 months, and all patients are asymptomatic for a success rate of 96%. Tailored treatment algorithms including FRRS, postoperative venograms with or without intervention, and the use of long-term anticoagulation seems to be required in this complicated group of young patients to achieve optimal results.

Original languageEnglish (US)
Pages (from-to)500-507
Number of pages8
JournalSurgery
Volume145
Issue number5
DOIs
StatePublished - May 2009
Externally publishedYes

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Thoracic Outlet Syndrome
Subclavian Vein
Ribs
Tissue Plasminogen Activator
Thrombosis
Therapeutics
Pathologic Constriction
Veins

ASJC Scopus subject areas

  • Surgery

Cite this

de León, R. A., Chang, D. C., Hassoun, H. T., Black, J. H., Roseborough, G. S., Perler, B. A., ... Freischlag, J. A. (2009). Multiple treatment algorithms for successful outcomes in venous thoracic outlet syndrome. Surgery, 145(5), 500-507. https://doi.org/10.1016/j.surg.2008.09.017

Multiple treatment algorithms for successful outcomes in venous thoracic outlet syndrome. / de León, Ricardo A.; 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.

In: Surgery, Vol. 145, No. 5, 05.2009, p. 500-507.

Research output: Contribution to journalArticle

de León, RA, Chang, DC, Hassoun, HT, Black, JH, Roseborough, GS, Perler, BA, Rotellini-Coltvet, L, Call, D, Busse, C & Freischlag, JA 2009, 'Multiple treatment algorithms for successful outcomes in venous thoracic outlet syndrome', Surgery, vol. 145, no. 5, pp. 500-507. https://doi.org/10.1016/j.surg.2008.09.017
de León RA, Chang DC, Hassoun HT, Black JH, Roseborough GS, Perler BA et al. Multiple treatment algorithms for successful outcomes in venous thoracic outlet syndrome. Surgery. 2009 May;145(5):500-507. https://doi.org/10.1016/j.surg.2008.09.017
de León, Ricardo A. ; 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. / Multiple treatment algorithms for successful outcomes in venous thoracic outlet syndrome. In: Surgery. 2009 ; Vol. 145, No. 5. pp. 500-507.
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abstract = "Background: We sought to determine the outcomes in patients presenting with venous thoracic outlet syndrome. Methods: Prospectively collected data from 67 patients between October 2003 and December 2007. The average age was 31 years (range, 16-54); the 37 males and 30 females presented on average 9.2 months (range, 1 month-6 years) after acute thrombosis. Four treatment algorithms were utilized. Results: In group 1, 3 patients presented with acute occlusion and received tissue plasminogen activator (tPA) and immediate first rib resection with scalenectomy (FRRS). One vein rethrombosed and was treated by intravenous tPA postoperatively. In group 2, 39 patients presented with stenotic subclavian veins an average of 22 weeks after their initial thrombosis, all of whom underwent FRRS followed by a venogram 2 weeks postoperatively: 25 had a tight stenosis and underwent venoplasty with anticoagulation; 13 had patent, nonstenotic subclavian veins, and 1 patient required tPA and venoplasty owing to rethrombosis. Two patients had their subclavian vein thrombose after venoplasty and were treated with anticoagulation, tPA, and venoplasty. In group 3, 11 patients presented with intermittent venous obstruction without thrombosis and underwent FRRS; 3 underwent venograms because of concerns of residual stenosis, 2 of whom required venoplasty postoperatively. Finally, in group 4, 14 patients presented with occluded subclavian veins and underwent FRRS with long-term anticoagulation. Eleven have recanalized at an average of 6 months (range, 2-12). Conclusion: Overall, 64 of 67 patients have patent subclavian veins after a median follow-up of 10 months, and all patients are asymptomatic for a success rate of 96{\%}. Tailored treatment algorithms including FRRS, postoperative venograms with or without intervention, and the use of long-term anticoagulation seems to be required in this complicated group of young patients to achieve optimal results.",
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AU - de León, Ricardo A.

AU - Chang, David C.

AU - Hassoun, Heitham T.

AU - Black, James H.

AU - Roseborough, Glen S.

AU - Perler, Bruce A.

AU - Rotellini-Coltvet, Lisa

AU - Call, Diana

AU - Busse, Christopher

AU - Freischlag, Julie A.

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N2 - Background: We sought to determine the outcomes in patients presenting with venous thoracic outlet syndrome. Methods: Prospectively collected data from 67 patients between October 2003 and December 2007. The average age was 31 years (range, 16-54); the 37 males and 30 females presented on average 9.2 months (range, 1 month-6 years) after acute thrombosis. Four treatment algorithms were utilized. Results: In group 1, 3 patients presented with acute occlusion and received tissue plasminogen activator (tPA) and immediate first rib resection with scalenectomy (FRRS). One vein rethrombosed and was treated by intravenous tPA postoperatively. In group 2, 39 patients presented with stenotic subclavian veins an average of 22 weeks after their initial thrombosis, all of whom underwent FRRS followed by a venogram 2 weeks postoperatively: 25 had a tight stenosis and underwent venoplasty with anticoagulation; 13 had patent, nonstenotic subclavian veins, and 1 patient required tPA and venoplasty owing to rethrombosis. Two patients had their subclavian vein thrombose after venoplasty and were treated with anticoagulation, tPA, and venoplasty. In group 3, 11 patients presented with intermittent venous obstruction without thrombosis and underwent FRRS; 3 underwent venograms because of concerns of residual stenosis, 2 of whom required venoplasty postoperatively. Finally, in group 4, 14 patients presented with occluded subclavian veins and underwent FRRS with long-term anticoagulation. Eleven have recanalized at an average of 6 months (range, 2-12). Conclusion: Overall, 64 of 67 patients have patent subclavian veins after a median follow-up of 10 months, and all patients are asymptomatic for a success rate of 96%. Tailored treatment algorithms including FRRS, postoperative venograms with or without intervention, and the use of long-term anticoagulation seems to be required in this complicated group of young patients to achieve optimal results.

AB - Background: We sought to determine the outcomes in patients presenting with venous thoracic outlet syndrome. Methods: Prospectively collected data from 67 patients between October 2003 and December 2007. The average age was 31 years (range, 16-54); the 37 males and 30 females presented on average 9.2 months (range, 1 month-6 years) after acute thrombosis. Four treatment algorithms were utilized. Results: In group 1, 3 patients presented with acute occlusion and received tissue plasminogen activator (tPA) and immediate first rib resection with scalenectomy (FRRS). One vein rethrombosed and was treated by intravenous tPA postoperatively. In group 2, 39 patients presented with stenotic subclavian veins an average of 22 weeks after their initial thrombosis, all of whom underwent FRRS followed by a venogram 2 weeks postoperatively: 25 had a tight stenosis and underwent venoplasty with anticoagulation; 13 had patent, nonstenotic subclavian veins, and 1 patient required tPA and venoplasty owing to rethrombosis. Two patients had their subclavian vein thrombose after venoplasty and were treated with anticoagulation, tPA, and venoplasty. In group 3, 11 patients presented with intermittent venous obstruction without thrombosis and underwent FRRS; 3 underwent venograms because of concerns of residual stenosis, 2 of whom required venoplasty postoperatively. Finally, in group 4, 14 patients presented with occluded subclavian veins and underwent FRRS with long-term anticoagulation. Eleven have recanalized at an average of 6 months (range, 2-12). Conclusion: Overall, 64 of 67 patients have patent subclavian veins after a median follow-up of 10 months, and all patients are asymptomatic for a success rate of 96%. Tailored treatment algorithms including FRRS, postoperative venograms with or without intervention, and the use of long-term anticoagulation seems to be required in this complicated group of young patients to achieve optimal results.

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