Dua Anahita, Rothenberg Kara A, Gologorsky Rebecca C, Deslarzes-Dubuis Celine, Lee Jason T
Division of Vascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA.
Division of Vascular Surgery, Department of Surgery, Stanford Hospital and Clinics, Stanford, CA.
Ann Vasc Surg. 2020 Jan;62:128-132. doi: 10.1016/j.avsg.2019.08.071. Epub 2019 Aug 30.
Rib resection in venous thoracic outlet syndrome (vTOS) may be approached via a transaxillary, supraclavicular, or infraclavicular approach based on surgeon preference. The purpose of this study was to evaluate long-term postoperative quality of life function after surgery for vTOS and to determine if there were long-term patency differences associated with the surgical approach or whether prophylactic postoperative venography was performed.
All patients with vTOS undergoing rib resection at a single institution were retrospectively reviewed. In 2012, we switched our approach to infraclavicular with postoperative venogram performed within 2 weeks of rib resection. Clinical records and imaging results were tabulated, and postoperative outcomes, complications, and long-term symptom follow up via the disabilities of the arm, shoulder, and hand score surveys. The disabilities of the arm, shoulder, and hand score ranges from 0 to 100 with lower numbers indicating better functional status (100 = worst).
During the 19-year study period, we performed 109 rib resections in patients with vTOS (mean age, 29.8 years). From 2000 to 2012, 54 patients were approached via a supraclavicular approach, and from 2012 to 2018, 55 patients were approached via an infraclavicular approach. There was a significant decrease in the number of complications in the infraclavicular cohort compared with the supraclavicular group. There was no difference in patency between the 2 groups even with a higher rate of postoperative venogram in the infraclavicular cohort. There was no difference in long-term the disabilities of the arm, shoulder, and hand scores. There was an increased rate of complications in the supraclavicular cohort as compared with the infraclavicular group (P < 0.05).
The infraclavicular approach in patients with vTOS is associated with a lower rate of complications, but long-term quality of life outcomes and patency are not different between groups.
静脉型胸廓出口综合征（vTOS）的肋骨切除术可根据外科医生的偏好，通过经腋路、锁骨上或锁骨下途径进行。本研究的目的是评估vTOS手术后的长期生活质量功能，并确定手术方式是否存在长期通畅性差异，以及术后是否进行了预防性静脉造影。
对在单一机构接受肋骨切除术的所有vTOS患者进行回顾性研究。2012年，我们改为锁骨下途径，并在肋骨切除术后2周内进行静脉造影。整理临床记录和影像学结果，并通过手臂、肩部和手部功能障碍评分调查对术后结果、并发症和长期症状进行随访。手臂、肩部和手部功能障碍评分范围为0至100，分数越低表明功能状态越好（100分表示最差）。
在19年的研究期间，我们对109例vTOS患者进行了肋骨切除术（平均年龄29.8岁）。2000年至2012年，54例患者采用锁骨上途径，2012年至2018年，55例患者采用锁骨下途径。与锁骨上组相比，锁骨下组的并发症数量显著减少。即使锁骨下组术后静脉造影率较高，两组之间的通畅性也没有差异。两组在手臂、肩部和手部功能障碍的长期评分上没有差异。与锁骨下组相比，锁骨上组的并发症发生率更高（P<0.05）。
vTOS患者采用锁骨下途径并发症发生率较低，但两组之间的长期生活质量结果和通畅性并无差异。
