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.
Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands.
Eur J Vasc Endovasc Surg. 2021 Jun;61(6):1017-1024. doi: 10.1016/j.ejvs.2021.02.048. Epub 2021 Mar 31.
The North American Society for Vascular Surgery (SVS) reporting standards for neurogenic thoracic outlet syndrome (NTOS) were published in 2016 to produce consistency in the diagnosis and treatment of NTOS, but outcomes resulting from following these standards are not yet available. The results of a standardised multidisciplinary care pathway for NTOS based on the North American SVS reporting standards for NTOS are reported.
Patients referred between August 2016 and December 2019 with suspected NTOS were evaluated in this single center prospective cohort study. Diagnosis and treatment were performed according to a care pathway based on the North American SVS reporting standards. The outcome of surgically treated patients was determined by the Derkash score, thoracic outlet syndrome disability scale (TDS), Cervical Brachial Score Questionnaire (CBSQ), Disability of the Arm Shoulder and Hands Dutch language version (DASH-DLV) and Short Form-12 (SF-12) at three, six, 12, and 24 months.
Of 856 referred patients, 476 (55.6%) patients were diagnosed with NTOS. Dedicated physiotherapy was successful in 186 patients (39.1%). Surgical treatment was performed in 290 (60.9%) patients of whom 274 were included in the follow up. At a mean follow up of 16.9 ± 9.2 months, significant improvement (p < .001) in TDS, CBSQ, DASH-DLV, and SF-12 scores was seen in the surgical group between baseline and all follow up intervals. Derkash outcome after surgical intervention was excellent in 83 (30.3%), good in 114 (41.6%), fair in 43 (15.7%), and poor in 34 (12.4%) of the patients. Complications occurred in 16 (5.8%) patients, and 32 (10.4%) patients experienced recurrent or persistent NTOS complaints.
A multidisciplinary care pathway based on the North American SVS reporting standards for NTOS helped to confirm the diagnosis in 56% of patients referred, and guided the selection of patients who might benefit from thoracic outlet decompression surgery after unsuccessful dedicated physiotherapy. Intermediate follow up showed good outcomes in the majority of surgically treated patients.
北美血管外科学会（SVS）于 2016 年发布了神经源性胸廓出口综合征（NTOS）的北美 SVS 报告标准，旨在使 NTOS 的诊断和治疗保持一致，但目前尚不清楚遵循这些标准的结果。本文报道了基于北美 SVS 报告标准的 NTOS 标准化多学科护理路径的结果。
本单中心前瞻性队列研究纳入了 2016 年 8 月至 2019 年 12 月期间疑似 NTOS 的患者。根据基于北美 SVS 报告标准的护理路径进行诊断和治疗。手术治疗患者的预后通过 Derkash 评分、胸廓出口综合征残疾量表（TDS）、颈椎臂评分问卷（CBSQ）、荷兰语残疾的手臂肩和手量表（DASH-DLV）和简短形式-12（SF-12）在 3、6、12 和 24 个月时进行评估。
在 856 名转诊患者中，476 名（55.6%）患者被诊断为 NTOS。186 名（39.1%）患者经专门的物理治疗成功。290 名（60.9%）患者接受了手术治疗，其中 274 名患者纳入了随访。在平均 16.9 ± 9.2 个月的随访中，手术组的 TDS、CBSQ、DASH-DLV 和 SF-12 评分在基线和所有随访间隔均有显著改善（p<.001）。手术后的 Derkash 结果为优 83 例（30.3%）、良 114 例（41.6%）、可 43 例（15.7%）、差 34 例（12.4%）。16 例（5.8%）患者出现并发症，32 例（10.4%）患者出现复发性或持续性 NTOS 症状。
基于北美 SVS 报告标准的 NTOS 多学科护理路径有助于在 56%的转诊患者中确认诊断，并指导选择那些在不成功的专门物理治疗后可能受益于胸廓出口减压手术的患者。中期随访显示，大多数手术治疗患者的结果良好。
