Dialysis Access Center, The Regional Medical Center, Orangeburg, SC.
Memorial Regional Hospital, Hollywood, FL.
Ann Vasc Surg. 2021 Jan;70:263-272. doi: 10.1016/j.avsg.2020.07.029. Epub 2020 Aug 6.
Thoracic outlet syndrome (TOS) refers to a constellation of compressive problems that occur at the thoracic outlet. TOS has been recognized since the 19th century, and the "modern" era of treatment, especially for neurogenic TOS, dates from at least the 1970s. Despite this, however, the incidence and prevalence of these syndromes are almost completely unknown. To attempt to answer this fundamental question, we established a prospective database of all patients who presented to our clinic with a diagnosis of potential TOS, as described below.
We established a database of all patients referred to our clinic from July 1, 2014 to May 2018. All subjective data, the tentative diagnosis, and plan at the time of the office visit were prospectively recorded. For patients with neurogenic TOS (NTOS), a standardized workup sheet was used based on the Society for Vascular Surgery's recently published reporting standards document. For patients with venous TOS (VTOS), diagnosis was made by clinical examination and ultrasound, and for those with arterial TOS (ATOS), by clinical examination, ultrasound, and cross-sectional imaging when needed.
From July 1, 2014, to May 1, 2018, 526 patients were referred to our institution with a diagnosis of possible TOS. Of these, 432 (82%) were referred with symptoms suggestive of NTOS, 84 (16%) with symptoms suggestive of VTOS, and 10 (2%) with findings and/or symptoms suggestive of ATOS. NTOS: After evaluation as per the algorithm previously mentioned, 234 patients (54%) were judged high suspicion for NTOS, 126 (30%) moderate suspicion, and 72 (17%) low suspicion; 360 (83%) of those originally referred were felt to potentially have NTOS. Of the 84 patients with VTOS, 25 (30%) presented with acute Paget-Schroetter syndrome, 41 (48%) with subacute or chronic occlusion, and 18 (21%) with McCleery's syndrome. Finally, 8 of the 10 limbs had true ATOS; of these, 6 (75%) underwent decompression and repair and 2 (25%) endovascular intervention only. Based on referral assumptions and population density in our area, the incidence of NTOS seems to be between 2 and 3 cases per 100,000 people per year and that of VTOS between 0.5 and 1 per 100,000 people per year, ATOS being sporadic. The ratio of those with decent suspicion for NTOS and VTOS, respectively, is about 80:20, whereas that of those undergoing surgical decompression is about 75:25.
The rates of NTOS and VTOS, as aforementioned, are approximately 25 and 8 per year in a metropolitan area of 1,000,000, respectively. Although a rare disease, these numbers are not insignificant, although are much lower than prior estimates.
胸廓出口综合征（TOS）是指胸廓出口处发生的一系列压迫性问题。自 19 世纪以来，人们就已经认识到 TOS，而“现代”的治疗时代，尤其是针对神经源性 TOS 的治疗时代，可以追溯到至少 20 世纪 70 年代。然而，尽管如此，这些综合征的发病率和患病率几乎完全未知。为了尝试回答这个基本问题，我们按照以下描述，为所有可能患有 TOS 的患者建立了一个前瞻性的临床数据库。
我们建立了一个从 2014 年 7 月 1 日到 2018 年 5 月期间到我们诊所就诊的所有患者的数据库。所有的主观数据、初步诊断和就诊时的治疗计划都被前瞻性地记录下来。对于神经源性 TOS（NTOS）患者，我们根据血管外科学会最近发布的报告标准文件使用了标准化的评估表。对于静脉性 TOS（VTOS）患者，通过临床检查和超声进行诊断，对于动脉性 TOS（ATOS）患者，通过临床检查、超声和必要时的横截面成像进行诊断。
从 2014 年 7 月 1 日到 2018 年 5 月 1 日，我们机构共收治了 526 名可能患有 TOS 的患者。其中，432 名（82%）患者因 NTOS 症状就诊，84 名（16%）患者因 VTOS 症状就诊，10 名（2%）患者因 ATOS 症状和/或体征就诊。NTOS：根据前文提到的算法进行评估后，234 名患者（54%）被高度怀疑患有 NTOS，126 名（30%）为中度怀疑，72 名（17%）为低度怀疑；360 名（83%）最初被转诊的患者被认为可能患有 NTOS。84 名 VTOS 患者中，25 名（30%）患有急性胸廓出口综合征，41 名（48%）患有亚急性或慢性闭塞，18 名（21%）患有 McCleery 综合征。最后，10 只肢体中有 8 只存在真正的 ATOS；其中，6 只（75%）进行了减压和修复，2 只（25%）只进行了血管内介入治疗。基于转诊假设和我们地区的人口密度，NTOS 的发病率似乎为每年每 10 万人 2 至 3 例，VTOS 的发病率为每年每 10 万人 0.5 至 1 例，ATOS 则较为罕见。分别对 NTOS 和 VTOS 有高度怀疑的患者比例约为 80:20，而接受手术减压的患者比例约为 75:25。
前文所述，在一个拥有 100 万人口的大都市地区，NTOS 和 VTOS 的发病率约为每年 25 例和 8 例。尽管是一种罕见疾病，但这些数字不容忽视，尽管远低于之前的估计。
