Abstract：
Venous thoracic outlet syndrome (VTOS) is a debilitating condition with several well-documented treatment paradigms. We reviewed the outcomes from a large academic institution of patients who had undergone transaxillary first rib resection with delayed venography (TA) or infraclavicular first rib and subclavius muscle resection with concomitant venography (ICV) for VTOS with subclavian vein thrombosis.
We performed a retrospective review of the medical records of all patients who had undergone first rib resection and scalenectomy for VTOS with subclavian vein thrombosis at a single academic institution. The demographics, presentation, operative records, and outcomes were collected. Descriptive statistics were used to compare the two groups.
A total of 73 patients had undergone first rib resection for VTOS during the study period. Of the 73 patients, 36 (49%) had presented with thrombosis of the subclavian vein and were included in the present review. Of the 36 patients, 26 (72%) had undergone TA and 10 (28%) had undergone ICV. No significant differences were seen between the two groups in female gender (54% vs 50%; P = 1.00) or age (28.7 years vs 29.5 years; P = .88). A higher percentage of the ICV group had undergone preoperative thrombolysis (70% vs 27%; P = .02). All the patients in the ICV group had undergone intraoperative balloon venoplasty at resection. The mean time from thrombosis to resection was 2.3 months. All of the TA group had undergone venography at 2 weeks postoperatively. Venography had revealed 15 stenotic veins requiring venoplasty, 8 widely patent veins, 1 acutely thrombosed vein, and 3 chronically occluded veins. The time from initial thrombosis to surgical intervention was 10 months for the patent group, 6 months for the stenotic group, and 4 months for the occluded group. In the TA group, 19% of the patients had required chest tube placement intraoperatively for pneumothorax. In the ICV group, complications included postoperative hematoma (n = 1), wound infection (n = 1), and hemothorax (n = 1). The mean length of stay was 1.04 days for the TA group and 2.00 days for the ICV group (P < .0001). The mean follow-up was 10.4 months and 15.8 months for the TA and ICV groups, respectively. No mortalities were reported. No differences in the vein patency rates were seen between the two groups at follow-up (TA, 93%; vs ICV, 100%; P = 1.00). All the patients were asymptomatic at follow-up.
The outcomes for the patients who had undergone TA or ICV for subclavian vein thrombosis were excellent with no mortality and few complications. The subclavian vein patency rates were high, and all the patients were asymptomatic at follow-up.
We performed a retrospective review of the medical records of all patients who had undergone first rib resection and scalenectomy for VTOS with subclavian vein thrombosis at a single academic institution. The demographics, presentation, operative records, and outcomes were collected. Descriptive statistics were used to compare the two groups.
A total of 73 patients had undergone first rib resection for VTOS during the study period. Of the 73 patients, 36 (49%) had presented with thrombosis of the subclavian vein and were included in the present review. Of the 36 patients, 26 (72%) had undergone TA and 10 (28%) had undergone ICV. No significant differences were seen between the two groups in female gender (54% vs 50%; P = 1.00) or age (28.7 years vs 29.5 years; P = .88). A higher percentage of the ICV group had undergone preoperative thrombolysis (70% vs 27%; P = .02). All the patients in the ICV group had undergone intraoperative balloon venoplasty at resection. The mean time from thrombosis to resection was 2.3 months. All of the TA group had undergone venography at 2 weeks postoperatively. Venography had revealed 15 stenotic veins requiring venoplasty, 8 widely patent veins, 1 acutely thrombosed vein, and 3 chronically occluded veins. The time from initial thrombosis to surgical intervention was 10 months for the patent group, 6 months for the stenotic group, and 4 months for the occluded group. In the TA group, 19% of the patients had required chest tube placement intraoperatively for pneumothorax. In the ICV group, complications included postoperative hematoma (n = 1), wound infection (n = 1), and hemothorax (n = 1). The mean length of stay was 1.04 days for the TA group and 2.00 days for the ICV group (P < .0001). The mean follow-up was 10.4 months and 15.8 months for the TA and ICV groups, respectively. No mortalities were reported. No differences in the vein patency rates were seen between the two groups at follow-up (TA, 93%; vs ICV, 100%; P = 1.00). All the patients were asymptomatic at follow-up.
The outcomes for the patients who had undergone TA or ICV for subclavian vein thrombosis were excellent with no mortality and few complications. The subclavian vein patency rates were high, and all the patients were asymptomatic at follow-up.
摘要：
背景：胸腔静脉出口综合征（VTOS）是一种衰弱的疾病，有几种有据可查的治疗范例。我们回顾了大型学术机构的结果，这些患者接受了经腋窝第一肋骨切除术并延迟静脉造影（TA）或锁骨下第一肋骨和锁骨下肌肉切除术并伴随静脉造影（ICV）治疗VTOS并锁骨下静脉血栓形成。
方法：我们对所有在单一学术机构接受首次肋骨切除和全膀胱切除术的VTOS伴锁骨下静脉血栓形成患者的病历进行了回顾性回顾。人口统计，介绍,手术记录,并收集结果。采用描述性统计比较两组。
结果：在研究期间，共有73例患者因VTOS进行了第一次肋骨切除术。在73名患者中，36例（49％）出现锁骨下静脉血栓形成，并纳入本综述。在36名患者中，26（72％）接受了TA，10（28％）接受了ICV。两组在女性性别（54％vs50％；P=1.00）或年龄（28.7岁vs29.5岁；P=0.88）之间没有显着差异。ICV组接受术前溶栓治疗的百分比更高（70％vs27％；P=0.02）。ICV组的所有患者在切除时都进行了术中球囊静脉成形术。从血栓形成到切除的平均时间为2.3个月。所有TA组在术后2周均进行了静脉造影。静脉造影显示15条狭窄静脉需要静脉成形术，8个广泛的专利静脉，1急性血栓形成的静脉，和3条慢性闭塞的静脉。从最初的血栓形成到手术干预的时间为10个月，狭窄组6个月，闭塞组4个月。在TA组中,19％的患者术中气胸需要放置胸管。在ICV组中，并发症包括术后血肿（n=1），伤口感染（n=1），和血胸（n=1）。TA组的平均住院时间为1.04天，ICV组为2.00天（P<0.0001）。TA和ICV组的平均随访时间为10.4个月和15.8个月，分别。没有死亡报告。两组随访时静脉通畅率无差异(TA,93%；与ICV相比，100%；P=1.00）。所有患者随访时无症状。
结论：接受TA或ICV治疗锁骨下静脉血栓形成的患者的预后良好，无死亡，并发症少。锁骨下静脉通畅率高，所有患者在随访时无症状。
方法：我们对所有在单一学术机构接受首次肋骨切除和全膀胱切除术的VTOS伴锁骨下静脉血栓形成患者的病历进行了回顾性回顾。人口统计，介绍,手术记录,并收集结果。采用描述性统计比较两组。
结果：在研究期间，共有73例患者因VTOS进行了第一次肋骨切除术。在73名患者中，36例（49％）出现锁骨下静脉血栓形成，并纳入本综述。在36名患者中，26（72％）接受了TA，10（28％）接受了ICV。两组在女性性别（54％vs50％；P=1.00）或年龄（28.7岁vs29.5岁；P=0.88）之间没有显着差异。ICV组接受术前溶栓治疗的百分比更高（70％vs27％；P=0.02）。ICV组的所有患者在切除时都进行了术中球囊静脉成形术。从血栓形成到切除的平均时间为2.3个月。所有TA组在术后2周均进行了静脉造影。静脉造影显示15条狭窄静脉需要静脉成形术，8个广泛的专利静脉，1急性血栓形成的静脉，和3条慢性闭塞的静脉。从最初的血栓形成到手术干预的时间为10个月，狭窄组6个月，闭塞组4个月。在TA组中,19％的患者术中气胸需要放置胸管。在ICV组中，并发症包括术后血肿（n=1），伤口感染（n=1），和血胸（n=1）。TA组的平均住院时间为1.04天，ICV组为2.00天（P<0.0001）。TA和ICV组的平均随访时间为10.4个月和15.8个月，分别。没有死亡报告。两组随访时静脉通畅率无差异(TA,93%；与ICV相比，100%；P=1.00）。所有患者随访时无症状。
结论：接受TA或ICV治疗锁骨下静脉血栓形成的患者的预后良好，无死亡，并发症少。锁骨下静脉通畅率高，所有患者在随访时无症状。
