Clinical Outcomes Of Medicare-aged Patients With Neurogenic Thoracic Outlet Syndrome
Meghan He1, Jenny Wang, BS1, Snehal Bindra, BS1, Lauren E. Jones, MS2, Robert W. Feldtman, MD2, Sam Ahn, MD2.
1University Vascular Associates, Los Angeles, CA, USA, 2DFW Vascular Group, Dallas, TX, USA.
OBJECTIVES:Recent Neurogenic Thoracic Outlet Syndrome (nTOS) studies reported greater surgical decompression efficacy in younger patients. However, the influence of age on physical therapy (PT) and percutaneous transluminal angioplasty (PTA) outcomes has not been established. We compare herein the treatment outcomes of nTOS patients age>65 and age<65.
METHODS:We retrospectively analyzed charts of 1579 nTOS patients from 2007-2019 (mean age 50, range 14-95). 316 (20%) were age>65 (mean age 73) and 1263 (80%) were age<65 (mean age 45). All patients underwent PT. Those who failed PT underwent diagnostic venography to assess for venous compression at the thoracic outlet. Patients underwent simultaneous PTA of the subclavian and/or internal jugular veins for stenosis>50%. We applied Chi-squared tests and Welch’s t-tests to evaluate differences among age groups.
RESULTS:Compared to age<65 patients, age>65 patients had higher rates of sustained symptom improvement with PT alone (242/316=77% vs 743/1263=59%, p<0.01) and higher rates of PTA benefit (56/74=76% vs 246/520=47%, p<0.01) (Figure 1). Average time between PTA and open surgery was longer in age≥65 than age<65 patients (179 vs 97 days, p=0.19). Overall, PT combined with PTA replaced the need for open surgery in 96% of age>65 patients (303/316) and 85% of age<65 (1101/1263) (p<0.01).
CONCLUSIONS:
Older nTOS patients are significantly more likely than younger patients to benefit from PT and PTA. Thus, treatment should not be withheld because of elder age. The combination of PT and PTA was highly effective in avoiding open surgery and thus should be considered prior to open surgery for all. 
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