Wang Jenny N, He Meghan, Bindra Snehal, Jones Lauren E, Blebea John, Ahn Samuel S
Division of Vascular Surgery, Department of Surgery, University of California Irvine School of Medicine, Irvine, CA.
Division of Vascular Surgery, Department of Surgery, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada.
Ann Vasc Surg. 2025 Oct;119:91-98. doi: 10.1016/j.avsg.2025.04.129. Epub 2025 May 6.
To characterize the effects of percutaneous transluminal venous angioplasty (PTVA) on relieving the symptoms of neurogenic thoracic outlet syndrome (nTOS).
Charts of 1,194 consecutive nTOS patients from 2010 to 2019 were analyzed. A total of 887 patients found adequate relief with conservative physical therapy, whereas 307 patients failed physical therapy and underwent diagnostic venography. Of these 307 patients, 291 (mean age 51 years, 72% female, 28% male) were found to have significant venous stenosis and were treated with PTVA. The mean follow-up period for all subjects was 19 ± 27 months (median = 13 months).
Following PTVA, 173 (59%) reported initial symptomatic improvement, 60 (21%) no change, 52 (18%) worsened symptoms, and 6 (2%) were lost to follow-up. Furthermore, of the total 291 PTVA patients, 143 (49%) required no subsequent treatment, 48 (17%) had additional endovascular PTVA intervention, 93 (32%) eventually underwent open surgery, and 6 (2%) were lost to follow-up. Complications were seen in only one patient (0.3%) who had brief asymptomatic ventricular tachycardia in the recovery room. Overall, of the 285 patients treated with PTVA, 198 (69%) avoided open surgery.
PTVA appears to be safe and effective treatment for nTOS. PTVA reduced the need for open surgical decompression in over two-thirds of patients, and thus should be considered before surgical intervention.
描述经皮腔内静脉血管成形术（PTVA）对缓解神经源性胸廓出口综合征（nTOS）症状的效果。
分析了2010年至2019年连续1194例nTOS患者的病历。共有887例患者通过保守物理治疗获得了充分缓解，而307例患者物理治疗无效并接受了诊断性静脉造影。在这307例患者中，291例（平均年龄51岁，女性72%，男性28%）被发现存在明显的静脉狭窄，并接受了PTVA治疗。所有受试者的平均随访期为19±27个月（中位数=13个月）。
PTVA术后，173例（59%）报告最初症状改善，60例（21%）无变化，52例（18%）症状恶化，6例（2%）失访。此外，在总共291例PTVA患者中，143例（49%）无需后续治疗，48例（17%）接受了额外的血管内PTVA干预，93例（32%）最终接受了开放手术，6例（2%）失访。仅1例患者（0.3%）出现并发症，该患者在恢复室出现短暂无症状室性心动过速。总体而言，在接受PTVA治疗的285例患者中，198例（69%）避免了开放手术。
PTVA似乎是治疗nTOS的安全有效方法。PTVA使超过三分之二的患者减少了开放手术减压的需求，因此在手术干预前应予以考虑。
