Objective

Venous thoracic outlet syndrome (VTOS) is a rare disorder that occurs in young athletes and working adults. There are multiple published reports demonstrating excellent outcomes with thoracic outlet (TO) decompression surgery when patients present acutely (within 2 weeks of symptom onset). Our objective was to assess outcomes after decompression surgery in patients with acute, subacute, chronic, and secondary VTOS. Additionally, we sought to identify risk factors for persistence of symptoms following operative decompression.

Methods

A retrospective chart review was performed for all patients who underwent operative decompression for VTOS at the University of Pittsburgh Medical Center from 2013 to 2017. We examined baseline characteristics, comorbidities, presenting symptoms, interventions performed, and postoperative clinical outcomes. Patients were characterized as acute, subacute, or chronic based on onset of symptoms and presentation to our surgeons (acute <2 weeks, subacute 2 weeks to 3 months, and chronic >3 months). Our outcomes of interest were return to baseline functional status as defined by resumption of sports activity or occupation and axillosubclavian vein patency.

Results

A total of 51 operative decompressions were performed in 48 patients for VTOS. There were 23 operations (45%) performed on patients who presented acutely, 7 (14%) in the subacute group, and 21 (41%) surgeries in patients with chronic symptoms. Of these 51 operations, 4 (7.8%) were deemed unsuccessful—two surgeries were in the acute group, one in the subacute, and one in the chronic group. The 30-day morbidity after 51 first rib resections included no pneumothoraces, no lymphatic leaks, two surgical site hematomas with associated hemothorax in one patient, two surgical site infections, and only two unplanned returns to the operating room for hematoma evacuation and superficial wound infection washout. In terms of preoperative vein patency, those who presented acutely were more likely to have an occluded axillosubclavian vein (P = .029). The Fisher's exact was 0.540, indicating that the proportion of patients returning to baseline functional status were similar when comparing acute presenters with those who present late. A multivariate Cox proportional hazards model was attempted; however, a small sample size greatly limited the power of the study and prohibited identification of risk factors for surgical failure.

Conclusions

Patients with acute and chronic VTOS resumed their preintervention sports activity or vocation after TO decompression in more than 90% of cases with a low incidence of adverse events. Based on our study results, patients with chronic VTOS benefit as much from TO decompression as those with acute VTOS.

中文翻译：

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急性与慢性静脉胸廓出口综合征的胸廓出口减压的术后结果

客观的

静脉胸廓出口综合征（VTOS）是一种罕见的疾病，发生在年轻运动员和在职成年人中。有多篇已发表的报告表明，当患者出现急性症状（在2周内出现症状）时，进行胸腔出口（TO）减压手术可取得出色的治疗效果。我们的目的是评估急性，亚急性，慢性和继发性VTOS患者减压手术后的结局。此外，我们试图确定手术减压后症状持续的危险因素。

方法

匹兹堡大学医学中心于2013年至2017年对所有接受VTOS手术减压的患者进行了回顾性图表审查。我们检查了基线特征，合并症，表现出的症状，所采取的干预措施和术后临床结局。根据症状发作和向我们的外科医生呈报（急性<2周，亚急性2周至3个月，慢性> 3个月），将患者分为急性，亚急性或慢性。我们感兴趣的结果是恢复到基线功能状态，这是恢复体育活动或职业以及腋下锁骨下静脉通畅所定义的。

结果

对于48例VTOS患者，总共进行了51次手术减压。急性表现的患者进行了23例手术（45％），亚急性组进行了7例手术（14％），慢性症状的患者进行了21例手术（41％）。在这51例手术中，有4例（7.8％）被认为不成功-急性组有2例手术，亚急性组有1例，慢性组有1例。第一次肋骨切除术后的30天发病率包括无气胸，无淋巴漏，一名患者有2处伴有血胸的手术部位血肿，2处手术部位感染以及仅有2例计划外返回手术室进行血肿清除和浅表伤口感染冲刷。就术前静脉通畅而言，表现为急性的患者更有可能发生腋窝锁骨下静脉阻塞（P  = .029）。Fisher的精确度为0.540，这表明当比较急性主诉者和晚期主诉者时返回基线功能状态的患者比例相似。尝试使用多变量Cox比例风险模型；然而，小样本量极大地限制了研究的能力，并禁止鉴定手术失败的危险因素。

结论

90％以上不良事件发生率较低的患者中，TO减压后，急性和慢性VTOS患者恢复了干预前的运动或职业。根据我们的研究结果，慢性VTOS患者与急性VTOS患者相比，从TO减压中获益最大。