Department of Vascular Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
Department of Vascular Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia.
Eur J Vasc Endovasc Surg. 2022 Dec;64(6):712-718. doi: 10.1016/j.ejvs.2022.08.019. Epub 2022 Aug 24.
Venous thoracic outlet syndrome (vTOS) is a relatively rare condition associated with significant morbidity. Its management continues to evolve, with increasing use of endovascular adjuncts, such as percutaneous thrombectomy and angioplasty, in addition to first rib resection. The utility of stenting residual venous stenotic lesions is poorly defined within the literature. This study sought to review the medium term patency rates of upper limb deep venous stenting in the management of vTOS.
A single centre, retrospective review of patients managed for vTOS with first rib resection followed by upper limb deep venous stenting between January 2012 and February 2021 was conducted. Post-procedural ultrasounds were reviewed to determine stent patency.
Twenty-six patients were included, with 33 stents placed. The median duration of follow up was 50 months. On venous duplex ultrasound at three years post-operatively, primary patency rates were 66%, primary assisted patency rates were 88%, secondary patency rates were 91%, and total occlusion rates were 9%. After stent placement, 80% of patients remained asymptomatic with regard to compression symptoms.
Upper limb deep venous stenting is an effective adjunct to surgical decompression in the management of vTOS. Stent medium term patency rates are promising; however, further studies with longer follow up and larger cohorts with multicentre results are required to confirm these early findings.
静脉型胸廓出口综合征（vTOS）是一种相对罕见的疾病，与较高的发病率相关。其治疗方法在不断发展，除了第一肋骨切除术之外，还越来越多地使用血管内辅助手段，如经皮血栓切除术和血管成形术。支架治疗残留静脉狭窄病变的效果在文献中尚未得到明确界定。本研究旨在评估上肢深静脉支架置入术在 vTOS 治疗中的中期通畅率。
回顾性分析 2012 年 1 月至 2021 年 2 月期间在接受第一肋骨切除术治疗 vTOS 后接受上肢深静脉支架置入术的单中心患者。术后超声检查评估支架通畅性。
共纳入 26 例患者，共置入 33 个支架。中位随访时间为 50 个月。术后 3 年行静脉双功超声检查，显示主要通畅率为 66%，主要辅助通畅率为 88%，次要通畅率为 91%，完全闭塞率为 9%。支架置入后，80%的患者压迫症状仍无症状。
上肢深静脉支架置入术是治疗 vTOS 的一种有效的手术减压辅助手段。支架中期通畅率令人鼓舞；然而，需要进一步进行更长时间随访和更大样本量、多中心研究，以证实这些早期发现。
