Abstract：
BACKGROUND: We evaluated the impact of completion intraoperative venography on clinical outcomes for axillosubclavian vein (AxSCV) thrombosis owing to venous thoracic outlet syndrome (vTOS).
METHODS: We performed a retrospective, single-center review of all patients with vTOS treated with first rib resection (FRR) and intraoperative venography from 2011 to 2023. We reviewed intraoperative venographic films to classify findings and collected demographics, clinical and perioperative variables, and clinical outcomes. Primary end points were symptomatic relief and primary patency at 3 months and 1 year. Secondary end points were time free from symptoms, reintervention rate, perioperative complications, and mortality.
RESULTS: Fifty-one AxSCVs (49 patients; mean age, 31.3 ± 12.6 years; 52.9% female) were treated for vTOS with FRR and external venolysis followed by completion intraoperative venography with a mean follow up of 15.5 ± 13.5 months. Before FRR, 32 underwent catheter-directed thrombolysis (62.7%). Completion intraoperative venography identified 16 patients with no stenosis (group 1, 31.3%), 17 with no stenosis after angioplasty (group 2, 33.3%), 10 with residual stenosis after angioplasty (group 3, 19.7%), and 8 with complete occlusion (group 4, 15.7%). The overall symptomatic relief was 44 of 51 (86.3%) and did not differ between venographic classifications (group 1, 14 of 16; group 2, 13 of 17; group 3, 10 of 10; and group 4, 7 of 8; log-rank test, P = .5). The overall 3-month and 1-year primary patency was 42 of 43 (97.7%) and 32 of 33 (97.0%), respectively (group 1, 16 of 16 and 9 of 9; group 2, 16 of 17 and 12 of 13; group 3, 10 of 10, 5 of 5; group 4, primary patency not obtained). There was one asymptomatic rethrombosis that resolved with anticoagulation, and three patients underwent reintervention with venous angioplasty for significant symptom recurrence an average 2.89 ± 1.7 months after FRR.
CONCLUSIONS: Our single-center retrospective study demonstrates that FRR with completion intraoperative venography has excellent symptomatic relief and short- and mid-term patency despite residual venous stenosis and complete occlusion. Although completion intraoperative venographic classification did not correlate with adverse outcomes, this protocol yielded excellent results and provides important clinical data for postoperative management. Our results also support a conservative approach to AxSCV occlusion identified after FRR.
METHODS: We performed a retrospective, single-center review of all patients with vTOS treated with first rib resection (FRR) and intraoperative venography from 2011 to 2023. We reviewed intraoperative venographic films to classify findings and collected demographics, clinical and perioperative variables, and clinical outcomes. Primary end points were symptomatic relief and primary patency at 3 months and 1 year. Secondary end points were time free from symptoms, reintervention rate, perioperative complications, and mortality.
RESULTS: Fifty-one AxSCVs (49 patients; mean age, 31.3 ± 12.6 years; 52.9% female) were treated for vTOS with FRR and external venolysis followed by completion intraoperative venography with a mean follow up of 15.5 ± 13.5 months. Before FRR, 32 underwent catheter-directed thrombolysis (62.7%). Completion intraoperative venography identified 16 patients with no stenosis (group 1, 31.3%), 17 with no stenosis after angioplasty (group 2, 33.3%), 10 with residual stenosis after angioplasty (group 3, 19.7%), and 8 with complete occlusion (group 4, 15.7%). The overall symptomatic relief was 44 of 51 (86.3%) and did not differ between venographic classifications (group 1, 14 of 16; group 2, 13 of 17; group 3, 10 of 10; and group 4, 7 of 8; log-rank test, P = .5). The overall 3-month and 1-year primary patency was 42 of 43 (97.7%) and 32 of 33 (97.0%), respectively (group 1, 16 of 16 and 9 of 9; group 2, 16 of 17 and 12 of 13; group 3, 10 of 10, 5 of 5; group 4, primary patency not obtained). There was one asymptomatic rethrombosis that resolved with anticoagulation, and three patients underwent reintervention with venous angioplasty for significant symptom recurrence an average 2.89 ± 1.7 months after FRR.
CONCLUSIONS: Our single-center retrospective study demonstrates that FRR with completion intraoperative venography has excellent symptomatic relief and short- and mid-term patency despite residual venous stenosis and complete occlusion. Although completion intraoperative venographic classification did not correlate with adverse outcomes, this protocol yielded excellent results and provides important clinical data for postoperative management. Our results also support a conservative approach to AxSCV occlusion identified after FRR.
摘要：
背景：我们评估了完整术中静脉造影对静脉胸腔出口综合征（vTOS）引起的颈锁骨下静脉（AxSCV）血栓形成的临床结果的影响。
方法：我们进行了回顾性研究，单中心回顾2011年至2023年接受第一肋骨切除术和术中静脉造影治疗的所有vTOS患者。我们回顾了术中静脉造影片，以对发现进行分类，收集的人口统计数据，临床和围手术期变量，和临床结果。主要终点是3个月和1年时的症状缓解和主要通畅。次要终点是没有症状的时间，再干预率，围手术期并发症,和死亡率。
结果：51例AxSCV（49例患者，平均年龄为31.3±12.6，女性为52.9％）接受vTOS治疗，采用第一肋骨切除术和外部静脉溶解术，然后完成术中静脉造影，平均随访15.5±13.5个月。在FRR之前，32例接受导管溶栓(62.7%)。完成术中静脉造影发现16例患者无狭窄（第1组，31.3%），17例血管成形术后无狭窄（第2组，33.3%），10例血管成形术后残余狭窄（第3组，19.7%），和8个完全闭塞（第4组，15.7%）。总体症状缓解为51个中的44个（86.3％），并且在静脉造影分类之间没有差异（第1组：16个中的14个，第2组：17个中的13个，第3组：10个中的10个，第4组：8个中的7个；对数秩检验，p=0.5)。总体3个月和1年原发性通畅率为43例中的42例（97.7%）和33例中的32例（97.0%），分别(第1组:16之16和9之9;第2组:17之16和13之12;第3组:10之10,5之5;第4组:未获得初级通畅)。有一例无症状的再血栓通过抗凝治疗解决，3例患者在FRR后平均2.89±1.7个月接受了静脉血管成形术的再干预，症状复发明显。
结论：我们的单中心回顾性研究表明，完整的术中静脉造影FRR具有极好的症状缓解，尽管残余静脉狭窄和完全闭塞，但短期和中期通畅。虽然完成术中静脉造影分类与不良结局无关，该方案取得了优异的结果,并为术后管理提供了重要的临床数据.我们的结果也支持FRR后识别的AxSCV闭塞的保守方法。
方法：我们进行了回顾性研究，单中心回顾2011年至2023年接受第一肋骨切除术和术中静脉造影治疗的所有vTOS患者。我们回顾了术中静脉造影片，以对发现进行分类，收集的人口统计数据，临床和围手术期变量，和临床结果。主要终点是3个月和1年时的症状缓解和主要通畅。次要终点是没有症状的时间，再干预率，围手术期并发症,和死亡率。
结果：51例AxSCV（49例患者，平均年龄为31.3±12.6，女性为52.9％）接受vTOS治疗，采用第一肋骨切除术和外部静脉溶解术，然后完成术中静脉造影，平均随访15.5±13.5个月。在FRR之前，32例接受导管溶栓(62.7%)。完成术中静脉造影发现16例患者无狭窄（第1组，31.3%），17例血管成形术后无狭窄（第2组，33.3%），10例血管成形术后残余狭窄（第3组，19.7%），和8个完全闭塞（第4组，15.7%）。总体症状缓解为51个中的44个（86.3％），并且在静脉造影分类之间没有差异（第1组：16个中的14个，第2组：17个中的13个，第3组：10个中的10个，第4组：8个中的7个；对数秩检验，p=0.5)。总体3个月和1年原发性通畅率为43例中的42例（97.7%）和33例中的32例（97.0%），分别(第1组:16之16和9之9;第2组:17之16和13之12;第3组:10之10,5之5;第4组:未获得初级通畅)。有一例无症状的再血栓通过抗凝治疗解决，3例患者在FRR后平均2.89±1.7个月接受了静脉血管成形术的再干预，症状复发明显。
结论：我们的单中心回顾性研究表明，完整的术中静脉造影FRR具有极好的症状缓解，尽管残余静脉狭窄和完全闭塞，但短期和中期通畅。虽然完成术中静脉造影分类与不良结局无关，该方案取得了优异的结果,并为术后管理提供了重要的临床数据.我们的结果也支持FRR后识别的AxSCV闭塞的保守方法。
