Our Summary

This research paper looks at a treatment method for chronic venous thoracic outlet syndrome (VTOS), a condition where blood vessels in the upper chest become narrow or blocked over a period of three months or more. This can cause ongoing symptoms even after initial treatment. The study investigated a treatment that involves removing part of the first rib (transaxillary thoracic outlet decompression or TA-TOD), breaking up blood clots (external venolysis), and widening the narrowed blood vessel (percutaneous transluminal angioplasty or PTA).

The study looked at 40 patients with chronic VTOS from 2015 to 2019. Four had severe blockages that couldn’t be treated using this method, so they were excluded. After the initial treatment (TA-TOD), 31 patients still had some narrowing in their blood vessels. Five patients initially seemed to have no significant narrowing, but two did show some when further tested. This meant that 33 patients (92%) still had some narrowing after the initial treatment. All of these patients then had PTA to widen the blood vessels.

There were complications in five patients. After an average of 24 months, 30 out of the 36 patients (83%) were free from symptoms. The patients’ quality of life and ability to function had improved significantly compared to before the treatment, and 93% had returned to their daily activities.

The researchers concluded that this treatment method is effective for chronic VTOS, resulting in a good return to daily activity and significant improvements in patients’ quality of life and ability to function.

FAQs

  1. What is the treatment method investigated for chronic venous thoracic outlet syndrome in this study?
  2. How many patients in the study still had some narrowing in their blood vessels after the initial treatment?
  3. What were the results and conclusion of the treatment method for chronic venous thoracic outlet syndrome according to the study?

Doctor’s Tip

A doctor might tell a patient undergoing thoracic outlet syndrome surgery to follow post-operative instructions carefully, including proper wound care and physical therapy exercises to aid in recovery and prevent complications. It is important to attend follow-up appointments to monitor progress and address any concerns promptly. Additionally, maintaining a healthy lifestyle with regular exercise and proper posture can help prevent recurrence of symptoms.

Suitable For

Thoracic outlet syndrome surgery is typically recommended for patients with chronic thoracic outlet syndrome (TOS) who have not responded well to conservative treatments such as physical therapy, medication, and lifestyle modifications. Patients who experience severe and persistent symptoms such as pain, numbness, weakness, and swelling in the arms, hands, and fingers may be candidates for surgery.

Specifically, patients with chronic venous thoracic outlet syndrome (VTOS) may be recommended for surgery if they have narrowing or blockage of the blood vessels in the upper chest that is causing ongoing symptoms despite initial treatment. In the study mentioned above, patients with chronic VTOS who had severe blockages that could not be treated using other methods were considered for surgery to remove part of the first rib and widen the narrowed blood vessels.

Overall, patients who are recommended for thoracic outlet syndrome surgery are those who have not experienced significant improvement in their symptoms with conservative treatments and whose condition is impacting their quality of life and ability to function. It is important for patients to discuss the potential risks and benefits of surgery with their healthcare provider to determine if it is the right treatment option for them.

Timeline

Before the surgery, patients may experience symptoms of chronic venous thoracic outlet syndrome, such as pain, swelling, and discoloration in the affected arm. They may also have difficulty performing daily activities due to the narrowed blood vessels in the upper chest.

After the surgery, patients may experience some complications, such as infection or bleeding. However, after an average of 24 months, the majority of patients (83%) were free from symptoms and had significant improvements in their quality of life and ability to function. The patients were able to return to their daily activities, indicating successful treatment outcomes for chronic VTOS with the TA-TOD, external venolysis, and PTA method.

What to Ask Your Doctor

Some questions a patient should ask their doctor about thoracic outlet syndrome surgery include:

  1. What are the potential risks and complications associated with the surgery?
  2. What is the expected outcome of the surgery in terms of symptom relief and improvement in quality of life?
  3. How long is the recovery period and what can I expect during the recovery process?
  4. Will I need physical therapy or rehabilitation after the surgery?
  5. Are there any alternative treatment options available for thoracic outlet syndrome?
  6. How often do patients experience a recurrence of symptoms after this type of surgery?
  7. What is the success rate of this surgery for patients with chronic venous thoracic outlet syndrome specifically?
  8. Will I need any additional procedures or treatments after the initial surgery?
  9. How experienced is the surgical team in performing thoracic outlet syndrome surgery?
  10. What can I do to prepare for the surgery and optimize my chances for a successful outcome?

Reference

Authors: Pesser N, Bode A, Goeteyn J, Hendriks J, van Nuenen BFL, Illig KA, van Sambeek MRHM, Teijink JAW. Journal: J Vasc Surg Venous Lymphat Disord. 2021 Sep;9(5):1159-1167.e2. doi: 10.1016/j.jvsv.2020.12.079. Epub 2021 Jan 8. PMID: 33429091