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Endovascular Interventions In The Treatment Of Venous Thoracic Outlet Syndrome
Mark G. Davies, MD PhD MBA1, Joseph P. Hart, MD MHL
2.
1Ascension Health, Waco, TX, USA,
2Medical College of Wisconsin, Milwaukee, WI, USA.
Objective: Endovascular management of vTOS presenting as “effort thrombosis” occurs in several phases: diagnostic, preoperative therapeutic intervention before decompression, postoperative interventions after decompression, and delayed interventions in the follow-up after decompression. This study examines the current evidence for its endovascular management.
Methods. A systematic review using the PRISMA guidelines was performed from 1992 to 2022 with the search terms venous TOS and endovascular or thrombolysis and decompression. The methodological quality of the studies was assessed with the MINORS tool, and bias was assessed with the Newcastle-Ottawa Tool.
Results: 4000 patients have been treated for vTOS and reported in the literature since 1970 in 90 retrospective case series and 16 case reports (Table 1). Declotting was followed by surgical decompression in 53% of patients, while in the remainder, surgical decompression alone (18%), endovascular intervention alone (15%), or conservative therapy with anticoagulation (15%) was performed. The initial intervention was predominantly catheter-directed thrombolysis, with <10% of cases undergoing concomitant balloon angioplasty. 93% of cases were successful. In the postoperative phase, balloon angioplasty was performed to correct residual intrinsic SCV disease after vTOS decompression in under 15% of cases. Stents were rarely deployed. Symptom relief was reported as 94±12% (mean ± SD) and 90±23%, respectively for declotting with decompression and declotting alone(Table 1). In the delayed phase, balloon angioplasty was performed in under 15% of cases to re-establish patency. The methodology quality was low, and the risk of bias was high.
Conclusion: Only 50% of cases in the literature report preoperative endovascular intervention
followed by decompression for “effort thrombosis” Intervention with or without a declotting procedure is superior to conservative management.
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