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Diagnostics 2017, 7(2), 34;

Vascular TOS—Creating a Protocol and Sticking to It

Division of Vascular Surgery, Department of Surgery, Ronald Reagan Medical Center at the University of California, Los Angeles, CA 90095, USA
Authors to whom correspondence should be addressed.
Academic Editors: Julie Ann Freischlag and Natalia O. Glebova
Received: 17 March 2017 / Revised: 27 May 2017 / Accepted: 4 June 2017 / Published: 10 June 2017
(This article belongs to the Special Issue Diagnosis and Treatment of Thoracic Outlet Syndrome)
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Thoracic Outlet Syndrome (TOS) describes a set of disorders that arise from compression of the neurovascular structures that exit the thorax and enter the upper extremity. This can present as one of three subtypes: neurogenic, venous, or arterial. The objective of this section is to outline our current practice at a single, high-volume institution for venous and arterial TOS. VTOS: Patients who present within two weeks of acute deep vein thrombosis (DVT) are treated with anticoagulation, venography, and thrombolysis. Those who present later are treated with a transaxillary first rib resection, then a two-week post-operative venoplasty. All patients are anticoagulated for 2 weeks after the post-operative venogram. Those with recurrent thrombosis or residual subclavian vein stenosis undergo repeat thrombolysis or venoplasty, respectively. ATOS: In patients with acute limb ischemia, we proceed with thrombolysis or open thrombectomy if there is evidence of prolonged ischemia. We then perform a staged transaxillary first rib resection followed by reconstruction of the subclavian artery. Patients who present with claudication undergo routine arterial duplex and CT angiogram to determine the pathology of the subclavian artery. They then undergo decompression and subclavian artery repair in a similar staged manner. View Full-Text
Keywords: thoracic outlet syndrome (TOS); thoracic outlet syndrome; vascular TOS (VTOS); arterial TOS (ATOS) thoracic outlet syndrome (TOS); thoracic outlet syndrome; vascular TOS (VTOS); arterial TOS (ATOS)

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Archie, M.; Rigberg, D. Vascular TOS—Creating a Protocol and Sticking to It. Diagnostics 2017, 7, 34.

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