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- Title
Vascular TOS--Creating a Protocol and Sticking to It.
- Authors
Archie, Meena; Rigberg, David
- Abstract
Thoracic Outlet Syndrome (TOS) describes a set of disorders that arise from compression of the neurovascular structures that exit the thorax and enter the upper extremity. This can present as one of three subtypes: neurogenic, venous, or arterial. The objective of this section is to outline our current practice at a single, high-volume institution for venous and arterial TOS. VTOS: Patients who present within two weeks of acute deep vein thrombosis (DVT) are treated with anticoagulation, venography and thrombolysis. Those who present later are treated with a transaxillary first rib resection, then a two-week post-operative venoplasty. All patients are anticoagulated for 2 weeks after the post-operative venogram. Those with recurrent thrombosis or residual subclavian vein stenosis undergo repeat thrombolysis or venoplasty, respectively. ATOS: In patients with acute limb ischemia, we proceed with thrombolysis or open thrombectomy if there is evidence of prolonged ischemia. We then perform a staged transaxillary first rib resection followed by reconstruction of the subclavian artery. Patients who present with claudication undergo routine arterial duplex and CT angiogram to determine the pathology of the subclavian artery. They then undergo decompression and subclavian artery repair in a similar staged manner.
- Subjects
THORACIC outlet syndrome; UPPER extremity deep vein thrombosis; CHEST (Anatomy); VENOGRAPHY; THROMBOLYTIC therapy; DIAGNOSIS
- Publication
Diagnostics (2075-4418), 2017, Vol 7, Issue 2, p34
- ISSN
2075-4418
- Publication type
Article
- DOI
10.3390/diagnostics7020034