Department of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Department of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
J Vasc Surg Venous Lymphat Disord. 2021 Mar;9(2):321-328. doi: 10.1016/j.jvsv.2020.05.010. Epub 2020 May 26.
Venous thoracic outlet syndrome (VTOS) is a rare disorder that occurs in young athletes and working adults. There are multiple published reports demonstrating excellent outcomes with thoracic outlet (TO) decompression surgery when patients present acutely (within 2 weeks of symptom onset). Our objective was to assess outcomes after decompression surgery in patients with acute, subacute, chronic, and secondary VTOS. Additionally, we sought to identify risk factors for persistence of symptoms following operative decompression.
A retrospective chart review was performed for all patients who underwent operative decompression for VTOS at the University of Pittsburgh Medical Center from 2013 to 2017. We examined baseline characteristics, comorbidities, presenting symptoms, interventions performed, and postoperative clinical outcomes. Patients were characterized as acute, subacute, or chronic based on onset of symptoms and presentation to our surgeons (acute <2 weeks, subacute 2 weeks to 3 months, and chronic >3 months). Our outcomes of interest were return to baseline functional status as defined by resumption of sports activity or occupation and axillosubclavian vein patency.
A total of 51 operative decompressions were performed in 48 patients for VTOS. There were 23 operations (45%) performed on patients who presented acutely, 7 (14%) in the subacute group, and 21 (41%) surgeries in patients with chronic symptoms. Of these 51 operations, 4 (7.8%) were deemed unsuccessful-two surgeries were in the acute group, one in the subacute, and one in the chronic group. The 30-day morbidity after 51 first rib resections included no pneumothoraces, no lymphatic leaks, two surgical site hematomas with associated hemothorax in one patient, two surgical site infections, and only two unplanned returns to the operating room for hematoma evacuation and superficial wound infection washout. In terms of preoperative vein patency, those who presented acutely were more likely to have an occluded axillosubclavian vein (P = .029). The Fisher's exact was 0.540, indicating that the proportion of patients returning to baseline functional status were similar when comparing acute presenters with those who present late. A multivariate Cox proportional hazards model was attempted; however, a small sample size greatly limited the power of the study and prohibited identification of risk factors for surgical failure.
Patients with acute and chronic VTOS resumed their preintervention sports activity or vocation after TO decompression in more than 90% of cases with a low incidence of adverse events. Based on our study results, patients with chronic VTOS benefit as much from TO decompression as those with acute VTOS.
静脉型胸廓出口综合征（VTOS）是一种罕见疾病，主要发生于年轻运动员和成年劳动者。有大量文献报道显示，对于症状发作后 2 周内（急性发作）接受胸廓出口减压手术的患者，其效果极佳。我们的目的是评估急性、亚急性、慢性和继发性 VTOS 患者接受减压手术后的效果。此外，我们还试图确定术后减压后症状持续存在的风险因素。
对 2013 年至 2017 年期间在匹兹堡大学医学中心接受手术减压治疗 VTOS 的所有患者进行回顾性图表审查。我们检查了基线特征、合并症、临床表现、手术干预措施和术后临床结果。根据症状发作和就诊于我们外科医生的时间，患者被分为急性、亚急性或慢性（急性：<2 周；亚急性：2 周到 3 个月；慢性：>3 个月）。我们感兴趣的结果是恢复基线功能状态，具体表现为恢复运动活动或职业以及腋锁骨下静脉通畅。
在 48 例患者中，共进行了 51 例手术减压治疗 VTOS。23 例手术（45%）用于急性发作患者，7 例（14%）用于亚急性发作患者，21 例（41%）用于慢性发作患者。这 51 例手术中，4 例（7.8%）被认为是不成功的，其中 2 例在急性组，1 例在亚急性组，1 例在慢性组。51 例第一肋骨切除术后 30 天的发病率包括无气胸、无淋巴漏、1 例患者 1 例手术部位血肿伴血胸、2 例手术部位感染，仅 2 例因血肿清除和浅表伤口感染冲洗而计划返回手术室。在术前静脉通畅方面，急性发作患者更有可能出现腋锁骨下静脉阻塞（P =.029）。Fisher 确切概率为 0.540，表明比较急性和迟发性患者时，恢复基线功能状态的患者比例相似。尝试了多变量 Cox 比例风险模型；然而，由于样本量小，极大地限制了研究的效力，并且无法确定手术失败的风险因素。
急性和慢性 VTOS 患者在接受胸廓出口减压治疗后，超过 90%的患者恢复了术前的运动活动或职业，不良事件发生率较低。根据我们的研究结果，慢性 VTOS 患者从胸廓出口减压中获益与急性 VTOS 患者一样多。
