腋锁骨下静脉双重压迫所致静脉型胸廓出口综合征：一例报告
Venous Thoracic Outlet Syndrome Caused by Double Compression of the Axillosubclavian Vein: A Case Report.
作者信息
Pesser Niels, van den Houten Marijn M L, van Sambeek Marc R H M, Teijink Joep A W
机构信息
Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands.
CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands.
出版信息
EJVES Vasc Forum. 2020 Feb 27;47:38-41. doi: 10.1016/j.ejvsvf.2020.02.002. eCollection 2020.
INTRODUCTION
In venous thoracic outlet syndrome (VTOS), pathology around the axillosubclavian vein causes venous compression with the subsequent development of upper extremity symptoms. This case report describes the analysis of all possible compression sites and subsequent treatment of VTOS patients with multiple compression points.
REPORT
A 22 year old male presented with severe pain and swelling in his right arm, which persisted after a conservatively managed primary upper extremity deep vein thrombosis. Compression of the axillosubclavian vein was seen both at the level of the pectoralis minor and the costoclavicular spaces. Both compression points were successfully treated by combining thoracic outlet decompression surgery with pectoralis minor tenotomy.
DISCUSSION
This report underlines the importance of considering the possibility of multiple compression sites in patients with VTOS. Incomplete surgical release of all compression points leaves patients prone to re-thrombosis and/or persistent post-thrombotic syndrome. Timely recognition of all abnormalities on venography may allow for adjustment of surgical treatment accordingly.
引言
在静脉型胸廓出口综合征（VTOS）中，腋锁骨下静脉周围的病理改变导致静脉受压，随后出现上肢症状。本病例报告描述了对所有可能的压迫部位的分析以及对具有多个压迫点的VTOS患者的后续治疗。
报告
一名22岁男性出现右臂严重疼痛和肿胀，在保守治疗原发性上肢深静脉血栓形成后症状持续存在。在胸小肌水平和肋锁间隙均可见腋锁骨下静脉受压。通过胸廓出口减压手术联合胸小肌切断术成功治疗了两个压迫点。
讨论
本报告强调了在VTOS患者中考虑多个压迫部位可能性的重要性。所有压迫点的手术松解不完全会使患者易于再次发生血栓形成和/或持续存在血栓后综合征。及时识别静脉造影上的所有异常可能有助于相应地调整手术治疗。
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