European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery · 2026
Long Term Results of Surgical Treatment of Chronic Venous Thoracic Outlet Syndrome: A Single Centre Experience.
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Teijink Stijn B J, Yadav Reshabh, Dujardin Yves Y, Pesser Niels, Mees Barend M E, Houterman Saskia, Goeteyn Jens, Teijink Joep A W
Аннотация
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.
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.