The use of intravascular ultrasound in the management of thoracic outlet syndrome.

We have reviewed our early experience with intravascular ultrasound in the management of thoracic outlet syndrome. Eight patients presenting with symptoms of venous obstruction secondary to thoracic outlet syndrome have been evaluated by duplex ultrasound, contrast venography, and intravascular ultrasound (IVUS). IVUS was performed at the same time as venography, using the brachial venous access site. In all eight patients IVUS and venography were in agreement. IVUS was able to identify the etiology of the stenoses. Four of the six patients with abnormal IVUS studies have had surgery, and IVUS was used intraoperatively during three of these cases. Based on the demonstration of release of extrinsic compression by real time imaging, it was possible to limit the necessary dissection to two first rib resections alone and one resection of just the insertion of the pectoralis minor muscle. Three of the four patients have had complete resolution of their symptoms postoperatively. Currently, the average follow-up time is 13 months. One patient who was a current procedure has had a minor relapse at 6 months. There have been no complications. These results have shown that IVUS is a safe technique and is as accurate as venography in identifying the sites and degree of narrowing. IVUS provides additional data as well regarding the etiology of the underlying process. The intraoperative use of IVUS has proved helpful in decision-making to minimize the dissection necessary to release extrinsic venous compression. The operative results compare favorably with those found in the literature.