de Kleijn Robert J C M F, Schropp Ludo, Westerink Jan, van Hattum Eline S, Petri Bart-Jeroen, de Borst Gert J
Department of Vascular Surgery, University Medical Center, Utrecht, Netherlands.
Department of Internal Medicine, Isala Hospital, Zwolle, Netherlands.
Front Surg. 2023 Jan 16;9:1072536. doi: 10.3389/fsurg.2022.1072536. eCollection 2022.
The low prevalence of Arterial Thoracic Outlet Syndrome (ATOS) and diffuse symptomatology have resulted in limited data on optimal treatment strategies and long-term outcome. The aim of this study was to report and evaluate a single center experience with the treatment of ATOS including midterm patient reported outcome.
All patients treated for ATOS from 2004 to 2020 were retrospectively identified. Patients were divided into two groups based on presenting symptoms; ATOX group (Acute arterial occlusion with ischemia) and ATOS group (claudication symptoms). Baseline characteristics and treatment details were extracted from electronic patient files. A telephone survey was conducted to collect patients' follow-up data including a functional disability score using the Quick Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The primary endpoint of this study was symptom-free survival. Secondary endpoints were median QuickDASH scores during follow-up, postoperative complications and possible re-interventions.
A total of 20 patients (mean age 44.6 years, median follow-up 50.5 months) were included and divided into two groups (ATOX = 9, ATOS = 11). In the ATOX group, eight patients were primarily treated with catheter directed thrombolysis (CDT; = 5) or surgical thrombectomy ( = 3). All patients received staged thoracic outlet decompression surgery (TOD). In the ATOS group, 10 patients primarily received TOD and one patient was treated conservatively with physiotherapy. Seven ATOX patients and nine ATOS patients were symptom free at follow-up with a median QuickDASH score of 2.3 (IQR 12.5) and 2.3 (IQR 16.5) respectively. Ten complications occurred in the ATOX group; three bleeding complications, five re-occlusions, one arterial dissection and one occipital infarction. In the ATOS group five complications occurred; one perioperative bleeding complication, three re-occlusions and a stent fracture. Seven vs. five re-interventions were required in the ATOX and ATOS groups respectively.
The mid-term self-reported symptom free survival in both the ATOX as well as ATOS group seems acceptable while median QuickDASH scores in both groups indicate a very good functional outcome. This however comes at the cost of treatment related bleeding complications in especially the ATOX group presumably due to thrombolysis, and re-interventions required in almost one out of three patients.
动脉型胸廓出口综合征（ATOS）患病率较低且症状多样，导致关于最佳治疗策略和长期预后的数据有限。本研究旨在报告并评估单中心治疗ATOS的经验，包括中期患者报告的预后情况。
回顾性确定2004年至2020年期间所有接受ATOS治疗的患者。根据出现的症状将患者分为两组；ATOX组（急性动脉闭塞伴缺血）和ATOS组（间歇性跛行症状）。从电子患者档案中提取基线特征和治疗细节。进行电话调查以收集患者的随访数据，包括使用手臂、肩部和手部快速功能障碍（DASH）问卷的功能障碍评分。本研究的主要终点是无症状生存期。次要终点是随访期间的中位QuickDASH评分、术后并发症和可能的再次干预。
共纳入20例患者（平均年龄44.6岁，中位随访时间50.5个月），分为两组（ATOX组=9例，ATOS组=11例）。在ATOX组中，8例患者主要接受导管定向溶栓（CDT；n = 5）或手术取栓（n = 3）。所有患者均接受分期胸廓出口减压手术（TOD）。在ATOS组中，10例患者主要接受TOD，1例患者接受物理治疗保守治疗。7例ATOX患者和9例ATOS患者在随访时无症状，中位QuickDASH评分分别为2.3（四分位间距12.5）和2.3（四分位间距16.5）。ATOX组发生10例并发症；3例出血并发症、5例再闭塞、1例动脉夹层和1例枕叶梗死。在ATOS组发生5例并发症；1例围手术期出血并发症、3例再闭塞和1例支架骨折。ATOX组和ATOS组分别需要7次和5次再次干预。
ATOX组和ATOS组中期自我报告的无症状生存期似乎可以接受，而两组的中位QuickDASH评分均表明功能预后非常好。然而，这是以治疗相关的出血并发症为代价的，尤其是ATOX组可能由于溶栓治疗导致，并且几乎三分之一的患者需要再次干预。
