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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
REVIEWS CONTROVERSIES IN VENOUS DISEASES
Italian Journal of Vascular and Endovascular Surgery 2010 September;17(3):225-33
Controversies in the management of venous thoracic outlet syndrome
Doyle A. J., Illig K. A.
Division of Vascular Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA
Venous thoracic outlet syndrome is caused by compression of the subclavian vein by the junction of the first rib and clavicle at the anterior part of the thoracic outlet. Patients can have intermittent obstruction with stress maneuvers, asymptomatic venous injury, or acute occlusive thrombosis (Paget-Schroetter syndrome, or “effort thrombosis”) with subsequent chronic occlusion. The structures within the thoracic outlet are likely compressed to some extent in nearly all people, but little is known about why some patients develop effort thrombosis and some do not. Additionally, while clinical algorithms are well developed, reliable data are surprisingly sparse. It is known that untreated effort thrombosis leads to significant long-term morbidity in the majority of patients, and therefore most physicians have accepted thrombolysis followed by surgical decompression as standard of care for these patients. Significant dissenters exist, and little information as to the relationship between intermittent obstruction and effort thrombosis is available. This review discusses the pathophysiology and other details surrounding venous thoracic outlet syndrome, and attempts to describe what data exist and what are lacking.