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Original Article   

The Journal of Cardiovascular Surgery 2022 Sep 14

DOI: 10.23736/S0021-9509.22.12224-X

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Arterial thoracic outlet syndrome: a 30-year experience in a high volume referral centre

Lazar B. DAVIDOVIC 1, 2, Petar ZLATANOVIC 2 , Marko DRAGAS 1, 2, Igor KONCAR 1, 2, Mihajlo MICIC 2, David MATEJEVIC 2

1 Faculty of Medicine, University of Belgrade, Belgrade, Serbia; 2 Clinic for Vascular and Endovascular Surgery, University Clinical Centre of Serbia, Belgrade, Serbia


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BACKGROUND: The purpose of this study is to assess the clinical presentation and contemporary management of arterial thoracic outlet syndrome (TOS) in high-volume referral centre.
METHODS: We conducted a retrospective review of a prospectively maintained database of patients with TOS of any etiology between January 1st 1990 and 2021. Supra-, or combined supra-/infraclavicular approaches have been used for decompression/vascular reconstructions. The group was divided into two equal time periods: Period 1 (1990-2006, n=27) and Period 2 (2006-2021, n=36).
RESULTS: Sixty-three consecutive patients underwent surgical treatment due to arterial TOS. Period 2 had more patients who were asymptomatic (n=16, 44.4% vs n=0, 0%, p<0.001) and those presenting with critical hand ischaemia (n=12, 33.3% vs n=0, 0%, p=0.01), while acute limb ischaemia was more common in period 1 (n=16, 59.2% vs n=5, 13.9%, p<0.001). SA compression without lesion was more common in period 2 (n=16, 44.4% vs n=0, 0%, p<0.001), while SA intimal damage with mural thrombus formation was more common in the period 1 (n=12, 44.4% vs n=1, 2.7%, p<0.001). Decompression as an isolated procedure was performed in 25.4% (n=16) of all asymptomatic patients, while combined decompressive and vascular procedure in 71.4% (n=45) of patients. The most common postoperative complication was pneumothorax (n=7, 11.1%).
CONCLUSIONS: The supraclavicular approach with its modifications provides adequate decompression and allows also repair or reconstruction of the SA, as well as complete additional revascularisation of the upper extremity without the need for further patient repositioning. While treatment methods and early outcomes have not changed significantly over time, there has been a trend towards different clinical and SA pathomorphologic presentation.


KEY WORDS: Thoracic outlet syndrome; Surgery; Decompression

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