Anatomy and Pathophysiology of VTOS

Urschel, Harold C.; Pool, Jim; Patel, Amit N.

doi:10.1007/978-1-4471-4366-6_49

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…The sides are formed by the subclavius/costoclavicular ligament medially and the anterior scalene muscle laterally. 15 The clavicle and first rib join together at a fulcrum and allow extreme force to be applied between them, in the region the vein resides ( Figure 1). This problem is further exacerbated by activities that require repetitive overhead movement of the upper extremity, such as pitchers, mechanics, weightlifters and others.…”

Section: Anatomy/pathophysiologymentioning

confidence: 99%

Venous thoracic outlet syndrome

Moore

Lum

2015

Vasc Med

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Venous thoracic outlet syndrome is a complex but rare disease that often can have excellent outcomes if quickly recognized and treated. The syndrome results from compression of the subclavian vein along its exit from the thoracic cavity and frequently affects young otherwise healthy patients. Modern diagnosis is made with a combination of clinical exam, appropriate non-invasive imaging, and, finally, contrast venography, which can be both diagnostic and therapeutic. Treatments have evolved over time to the point where patients can undergo less extensive procedures than previously performed and still maintain excellent outcomes. One of the most important predictors of outcome is the initiation of treatment within 14 days of symptoms. Hence, the importance of the accurate and prompt diagnosis of this syndrome in patients with an upper-extremity deep vein thrombotic episode cannot be further underscored. This review is a concise summary of the background and treatment algorithm for this patient population.

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Section: Anatomy/pathophysiologymentioning

confidence: 99%

Venous thoracic outlet syndrome

Moore

Lum

2015

Vasc Med

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“…High flow leads to dilatation and wall thickening. The subclavian vein traverses a short and narrow anatomical plane between the clavicle and 1st rib resulting in a potential area for physiological and pathological compression termed the costoclavicular triangle ( 2 ). This narrow anatomical space leads to physiological compression with arm movements, functional compression without symptoms, and symptomatic compression leading to arm symptoms and often access malfunction.…”

Section: Anatomymentioning

confidence: 99%

Venous thoracic outlet syndrome and hemodialysis

Hart

2023

Front. Surg.

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Central venous stenotic disease is reported in 7%–40% of patients needing a central venous catheter for dialysis and in 19%–41% of hemodialysis patients who have had a prior central venous catheter. Half of these patients will be asymptomatic. Venous Thoracic Outlet syndrome in hemodialysis (hdTOS) is part of this spectrum of disease. The extrinsic mechanical compression of the subclavian vein at the costoclavicular triangle between the clavicle and 1st rib results in an area of external compression with a predisposition to intrinsic mural disease in the vein. The enhanced flow induced by the presence of a distal arteriovenous access in all patients exacerbates the subclavian vein’s response to ongoing extrinsic and intrinsic injury. Repeated endovascular interventions during the maintenance of vascular access accelerates chronic untreatable occlusion of the subclavian vein in the long term. Similar to patients with central venous stenosis, patients with hdTOS can present immediately after access formation with ipsilateral edema or longitudinally with episodes of access dysfunction. hdTOS can be treated in an escalating manner with arteriovenous access flow reduction to <1,500 ml/min, endovascular management, surgical decompression by first rib resection in healthy patients and medial clavicle resection in less healthy patients followed by secondary venous interventions, or finally, a venous bypass. hdTOS represents a complex and evolving therapeutic conundrum for the dialysis community, and additional clinical investigations to establish robust algorithms are required.

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“…The pathophysiology is a chronic compression of the SCV in the costoclavicular space, resulting in progressive venous stenosis that predisposes to thrombosis. 1 The diagnosis is based on physical examination followed by catheter-based venography and the initial treatment is pharmaco-mechanical thrombolysis. After revascularization of SCV, patients are maintained with anticoagulation and surgery to decompress the costoclavicular angle, usually involving transaxillary first rib resection is usually planned within 4 to 6 weeks.…”

Section: Reportmentioning

confidence: 99%

The treatment of upper extremities deep vein thrombosis related to thoracic outlet syndrome with direct oral anticoagulants

et al. 2020

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Venous thoracic outlet syndrome (VTOS) is a manifestation of venous symptoms that occurs when the subclavian vein is compressed and it may present clinically with acute venous thrombosis of the axillo-subclavian vein. Evidence for the optimal approach to the management of this condition is sparse and actually anticoagulation alone is not considered an option. Herein we reported our experience with direct oral anticoagulants in patients with upper extremities deep vein thrombosis, due to VTOS, who refused endovascular approach or surgery.

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Anatomy and Pathophysiology of VTOS

Cited by 4 publications

References 10 publications

Venous thoracic outlet syndrome

Venous thoracic outlet syndrome

Venous thoracic outlet syndrome and hemodialysis

The treatment of upper extremities deep vein thrombosis related to thoracic outlet syndrome with direct oral anticoagulants

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