| 1. Demondion X, Herbinet P, Van Sint Jan S, Boutry N, Chantelot C, Cotten A. Imaging assessment of thoracic outlet syndrome. Radiographics. 2006; 26(6):1735-1750. |
Review/Other-Dx |
N/A |
To review the anatomy of the thoracic outlet and discuss and illustrate the functional anatomy, clinical features, causes, imaging features, and treatment of TOS. |
Diagnosis of TOS is based on the results of clinical evaluation, particularly if symptoms can be reproduced when various dynamic maneuvers, including elevation of the arm, are undertaken. However, clinical diagnosis is often difficult; thus, the use of imaging is required to demonstrate neurovascular compression and to determine the nature and location of the structure undergoing compression and the structure producing the compression. Cervical plain radiography should be performed first to assess for bone abnormalities and to narrow the differential diagnosis. |
4 |
| 2. Hussain MA, Aljabri B, Al-Omran M. Vascular Thoracic Outlet Syndrome. [Review]. Semin Thorac Cardiovasc Surg. 28(1):151-7, 2016. |
Review/Other-Dx |
N/A |
To discuss the anatomical factors, etiology, pathogenesis and clinical presentation of vascular Thoracic Outlet Syndrome (TOS) patients. |
No results stated in abstract. |
4 |
| 3. Thompson JF, Winterborn RJ, Bays S, White H, Kinsella DC, Watkinson AF. Venous thoracic outlet compression and the Paget-Schroetter syndrome: a review and recommendations for management. Cardiovasc Intervent Radiol. 2011; 34(5):903-910. |
Review/Other-Tx |
N/A |
To review literature and present the Exeter Protocol along with practical recommendations for management of Paget-Schroetter syndrome. |
No results stated in abstract. |
4 |
| 4. Thompson JF, Jannsen F. Thoracic outlet syndromes. Br J Surg. 83(4):435-6, 1996 Apr. |
Review/Other-Dx |
Evaluate 110 patients and operated on 35 |
To review diagnosis and management of TOS. |
Successful treatment of TOS depends on accurate diagnosis, patient selection and meticulous surgery. Duplex scanning, MRI and a careful neurophysiological assessment may improve objectivity, and lead to a more widespread appreciation of the different guises of this challenging condition. |
4 |
| 5. Angle N, Gelabert HA, Farooq MM, et al. Safety and efficacy of early surgical decompression of the thoracic outlet for Paget-Schroetter syndrome. Ann Vasc Surg. 15(1):37-42, 2001 Jan. |
Review/Other-Tx |
18 consecutive patients |
To compare early surgical decompression with the standard management protocol to determine safety and efficacy of the early treatment algorithm. |
Symptoms on presentation were similar in both groups. Each patient in both groups had upper extremity swelling, and 5/9 (56%) in the staged treatment group and 3/9 (33%) in the early treatment group presented with pain. Paresthesias were present in 2/9 patients in the staged treatment group and in none of the patients in the early treatment group. Results showed that thrombolysis followed by early operation does not result in increased perioperative morbidity or mortality. Early surgical decompression of the thoracic outlet during the same admission as lysis is as safe and efficacious as the traditional (staged decompression) approach to Paget-Schroetter syndrome. Lysis followed by early surgical decompression should be considered a new standard of care in the management of Paget-Schroetter syndrome. |
4 |
| 6. Aljabri B, Al-Omran M. Surgical management of vascular thoracic outlet syndrome: a teaching hospital experience. Ann Vasc Dis. 6(1):74-9, 2013. |
Review/Other-Dx |
54 patients |
To highlight the different modalities of diagnosing and treating vascular Thoracic Outlet Syndrome (TOS) and evaluate outcomes. |
During the study period, 54 cases with vascular TOS were identified in 38 patients. Bilateral TOS was in 16 patients. The median age of the patients was 33 years (range 12–49), and the majority (79%) were female. Arterial TOS represented forty-nine cases (90.7%). Preoperative information derived from plain x-ray, duplex scanning and in selected cases computed tomography (CT) and/or angiography. Decompression of the TOS was performed through a supraclavicular approach in all cases with scalenectomy coupled with either cervical rib excision (70%), 1st rib excision alone (15%) and excision of both cervical and 1st ribs (15%). Adjunctive vascular reconstructive procedures were done in 11 cases (20.3%); 9 arterial cases and 2 venous cases. There was no mortality; however, postoperative complications occurred in 7 cases (13%). |
4 |
| 7. Doyle A, Wolford HY, Davies MG, et al. Management of effort thrombosis of the subclavian vein: today's treatment. Ann Vasc Surg. 21(6):723-9, 2007 Nov. |
Review/Other-Tx |
34 patients |
To assess the structure and results of the treatment algorithm that has evolved at the University of Rochester Medical Center among patients who presented with complete venous occlusion, with particular attention to factors influencing the role of thrombolysis and venous reconstruction decision making. |
Catheter-directed thrombolysis prior to planned immediate thoracic outlet decompression (TOD) was performed in 26 patients, while TOD alone was performed in eight. Time since onset of symptoms was the major factor influencing the decision, being a mean of 5.5 days in the 26 referred for lysis but 1 month to many years in the group who underwent surgery alone. In patients undergoing lysis, flow was restored in 16 (62%), of whom nine had a residual lesion. All but two of the 26 who received thrombolysis then underwent TOD with or without angioplasty, and 13 underwent venous reconstruction as well (eight of the 16 in whom patency had been restored and five of eight in whom it had not). Patients not undergoing lysis were managed by TOD, with five (62%) undergoing decompression alone and three (38%) undergoing formal venous reconstruction. Thrombolysis was not attempted (eight) or unsuccessful (four) in all 12 patients whose symptoms had been present for more than 14 days at presentation. At mean follow-up of 33 months, symptom resolution was almost universal. Primary patency at 5 years was 84% in the thrombolysis group and 83% in the TOD only group. |
4 |
| 8. Guzzo JL, Chang K, Demos J, Black JH, Freischlag JA. Preoperative thrombolysis and venoplasty affords no benefit in patency following first rib resection and scalenectomy for subacute and chronic subclavian vein thrombosis. J Vasc Surg. 52(3):658-62; discussion 662-3, 2010 Sep. |
Review/Other-Tx |
103 patients |
To retrospectively review our experience with this condition and compare the effectiveness of preoperative endovascular intervention with thrombolysis and venoplasty to anticoagulation alone in those undergoing first rib resection and scalenectomy (FRRS) to preserve subclavian vein patency. |
One hundred three patients had 110 FRRS for subclavian vein thrombosis (53 men, 50 women), seven of which had contralateral FRRS for thrombosis. The cohort averaged 31 years of age (range, 16-54 years) with an overall, mean follow-up time of 16 months (range, 1-52 months). Of the 110 veins evaluated, 45 underwent endovascular intervention (thombolysis, with or without venoplasty) prior to FRRS, and at 1 year, 41 (91%) were patent with improvement of symptoms. In the 65 veins on anticoagulation alone, 59 (91%) ultimately were patent, with symptomatic improvement in all. Overall, 91% (100/110) of subclavian veins were patent in patients completing follow-up, were asymptomatic, and back to their previous active lifestyle. |
4 |
| 9. Lee JT, Karwowski JK, Harris EJ, Haukoos JS, Olcott C 4th. Long-term thrombotic recurrence after nonoperative management of Paget-Schroetter syndrome. J Vasc Surg. 43(6):1236-43, 2006 Jun. |
Observational-Tx |
64 patients |
To determine the clinical predictors associated with long-term thrombotic recurrences necessitating surgical intervention after initial success with nonoperative management of patients with primary subclavian vein thrombosis. |
Of the 35 patients with successful nonoperative management, 8 (23%) developed recurrent thrombotic events of the same extremity at a mean follow-up time of 13 months after thrombolysis (range, 6-33 months). These eight patients subsequently underwent first-rib resection with a 100% success rate without further sequelae at a mean follow-up time of 51 months (range, 2-103 months). The other 27 patients remained symptom free at a mean follow-up interval of 55 months (range, 10-110 months). Bivariate analyses determined that the use of a stent during the initial thrombolysis was associated with thrombotic recurrence (P = .05). The recurrence group was also significantly younger than the asymptomatic group (22 vs 36 years; P = .01). Sex, being a competitive athlete, a history of trauma, whether the dominant arm was affected, time of delay to lysis, initial clot burden, response to original lysis, use of adjunctive balloons or mechanical thrombectomy devices, residual stenosis on venography, length of time on warfarin, and patency of the vein on follow-up duplex examination were all characteristics not associated with long-term recurrence after nonoperative management. |
2 |
| 10. Povlsen B, Hansson T, Povlsen SD. Treatment for thoracic outlet syndrome. [Review][Update of Cochrane Database Syst Rev. 2010;(1):CD007218; PMID: 20091624]. Cochrane Database Syst Rev. (11)CD007218, 2014 Nov 26. |
Review/Other-Tx |
N/A |
To evaluate the beneficial and adverse effects of the available operative and non-operative interventions for the treatment of Thoracic Outlet Syndrome (TOS) a minimum of six months after the intervention. |
This review was complicated by a lack of generally accepted criteria for the diagnosis of TOS and had to rely exclusively on the diagnosis of TOS by the investigators in the reviewed studies.We identified one study comparing natural progression with an active intervention. We found three randomized controlled trials (RCTs), but only two of them had a follow-up of six months or more, which was the minimum required follow-up for inclusion in the review. The first trial that met our requirements involved 55 participants with the ’disputed type’ of TOS and compared transaxillary first rib resection (TFRR) with supraclavicular neuroplasty of the brachial plexus (SNBP). The trial had a high risk of bias. TFRR decreased pain more than SNBP. There were no adverse effects in either group. The second trial that met these requirements analyzed 37 people with TOS of any type, comparing treatment with a botulinum toxin (BTX) injection into the scalene muscles with a saline placebo injection. This trial had a low risk of bias. There was no significant effect of treatment with the BTX injection over placebo in terms of pain relief or improvements in disability, but it did significantly improve paresthesias at six months’ follow-up. There were no adverse events of the BTX treatment above saline injection. |
4 |
| 11. Schneider DB, Dimuzio PJ, Martin ND, et al. Combination treatment of venous thoracic outlet syndrome: open surgical decompression and intraoperative angioplasty. J Vasc Surg. 40(4):599-603, 2004 Oct. |
Observational-Tx |
25 patients |
To evaluate the safety and efficacy of combined thoracic outlet decompression with intraoperative percutaneous angioplasty (PTA) performed in 1 stage. |
Intraoperative venography enabled identification of residual subclavian vein stenosis in 16 patients (64%), and all underwent intraoperative percutaneous angioplasty (PTA) with 100% technical success. Postoperative duplex scans documented subclavian vein patency in 23 patients (92%). Complications included subclavian vein recurrent thrombosis in 2 patients (8%), and both underwent percutaneous mechanical thrombectomy, with restoration of patency in 1 patient. One-year primary and secondary patency rates were 92% and 96%, respectively, at life-table analysis |
2 |
| 12. Remy-Jardin M, Remy J, Masson P, et al. CT angiography of thoracic outlet syndrome: evaluation of imaging protocols for the detection of arterial stenosis. J Comput Assist Tomogr. 24(3):349-61, 2000 May-Jun. |
Observational-Dx |
82 patients |
To evaluate the results of cross-sectional imaging and multiplanar and 3D reconstructions for the detection of thoracic outlet arterial stenosis on CT angiograms. |
The number of examinations coded with an excellent degree of arterial enhancement was significantly higher in Group 2 than in Group 1 [68 (71%) vs 35 (51%); P<0.001]. The sensitivity and specificity for detection of arterial stenosis were 67% and 96% for transverse CT scans, 69% and 94% for sagittal reformations, 71% and 99% for 3D-shaded surface displays, and 95% and 100% for volume-rendered images. Compared with the standard of reference, a concordant scoring of arterial stenosis severity was found in 54% of transverse CT scans, 84% of sagittal reformations, 78% of 3D-shaded surface displays, and 91% of volume-rendered images. Underestimation of stenosis was found in 43% of transverse CT scans and 10% of sagittal reformations; overestimation of stenosis was more frequent on 3D-shaded surface displays (16%) than on volume-rendered images (7%). The reader's experience was marked for the interpretation of cross-sectional images but did not influence the interpretation of 3D images. |
3 |
| 13. Remy-Jardin M, Remy J, Masson P, et al. Helical CT angiography of thoracic outlet syndrome: functional anatomy. AJR. 2000; 174(6):1667-1674. |
Observational-Dx |
79 symptomatic patients |
To determine the anatomic characteristics of the thoracic outlet in symptomatic patients before and after postural maneuver. |
A statistically significant difference was found between the distribution of the distances (maximum and costosubclavian) measured in the neutral position and after postural maneuver in groups 1 and 2. The median value of these distances was smaller after postural maneuver in groups 1 and 2. A statistically significant difference was found between the distribution of the distances (maximum and costosubclavian) measured in patients of group 1 with arterial stenosis and in patients of group 1 without arterial stenosis. A slight indentation of the anterior wall of the subclavian artery when it arches around the anterior scalene muscle was observed in 39 patients (64%) in group 1 and in 11 patients (61%) in group 2 in the neutral position, in 19 patients (31%) in group 1 and in 6 patients (33%) in group 2 after the postural maneuver. The predominant positional changes of the vascular structures were the posteroanterior displacement of the subclavian vessels observed in groups 1 and 2, the arch made by the subclavian artery above the first rib in 40 patients (66%) in group 1 and 9 patients (50%) in group 2, and the posterior displacement of the axillary artery observed in 36 patients (59%) in group 1 and in 12 patients (67%) in group 2. |
3 |
| 14. Rubin GD, Rofsky NM. CT and MR Angiography: Comprehensive Vascular Assessment. Philadelphia, PA: Lippincott, Williams& Wilkins; 2009. |
Review/Other-Dx |
N/A |
Book chapter. |
N/A |
4 |
| 15. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/body-cta.pdf. |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 16. Aralasmak A, Cevikol C, Karaali K, et al. MRI findings in thoracic outlet syndrome. Skeletal Radiology. 41(11):1365-74, 2012 Nov. |
Review/Other-Dx |
100 neurovascular bundles |
To review MRI findings in patients with TOS. |
71 neurovascular bundles were found to be abnormal: 16 arterial-venous-neurogenic, 20 neurogenic, 1 arterial, 15 venous, 8 arterial-venous, 3 arterial-neurogenic, and 8 venous-neurogenic TOS. Overall, neurogenic TOS was noted in 69%, venous TOS in 66%, and arterial TOS in 39%. The neurovascular bundle was most commonly compressed in the costoclavicular, mostly secondary to position, and very rarely compressed in the retropectoralis minor. The cause of TOS was congenital bone variations in 36%, congenital fibromuscular anomalies in 11%, and position in 53%. In 5%, there was unilateral brachial plexitis in addition to compression of the neurovascular bundle. Severe cervical spondylosis was noted in 14%, contributing to TOS symptoms. For evaluation of patients with TOS, visualization of the brachial plexus and cervical spine and dynamic evaluation of neurovascular bundles in the cervicothoracobrachial region are mandatory. |
4 |
| 17. Demondion X, Bacqueville E, Paul C, Duquesnoy B, Hachulla E, Cotten A. Thoracic outlet: assessment with MR imaging in asymptomatic and symptomatic populations. Radiology. 2003; 227(2):461-468. |
Observational-Dx |
35 healthy volunteers and 54 patients |
To compare the dynamic modifications of the thoracic outlet in asymptomatic volunteers and symptomatic patients and assess the presence and location of vasculonervous compressions in these two populations. |
Patients with TOS had a smaller costoclavicular distance after the postural maneuver (P<.001), a thicker subclavius muscle in both arm positions (P<.001), and a wider retropectoralis minor space after the postural maneuver (P<.001) than did volunteers. Venous compressions after the postural maneuver were observed in 47% of volunteers and 63% of patients at the prescalene space, in 54% of volunteers and 61% of patients at the costoclavicular space, and in 27% of volunteers and 30% of patients at the retropectoralis minor space. Arterial and nervous compressions, respectively, were seen in 72% and 7% of patients. No arterial or nervous compression was seen in volunteers. Except for venous thrombosis, vasculonervous compressions were demonstrated only with arm elevation. Only three thoracic outlet measurements differed significantly in both populations. |
3 |
| 18. Aralasmak A, Karaali K, Cevikol C, Uysal H, Senol U. MR imaging findings in brachial plexopathy with thoracic outlet syndrome. AJNR Am J Neuroradiol. 2010;31(3):410-417. |
Review/Other-Dx |
60 patients |
To review MR imaging findings of subjects with brachial plexopathy. Different varieties of BPL lesions and imaging techniques are discussed. |
MR imaging is valuable in the characterization of BPL lesions. In brachial plexopathy, common lesions can vary according to age groups. For a complete evaluation, visualization of the BPL, including its roots, spinal cord, and neural foramina, is mandatory. In suspicion of TOS, dynamic MR imaging evaluation of the BPL and subclavian vessels is added to routine protocol. |
4 |
| 19. Ersoy H, Steigner ML, Coyner KB, et al. Vascular thoracic outlet syndrome: protocol design and diagnostic value of contrast-enhanced 3D MR angiography and equilibrium phase imaging on 1.5- and 3-T MRI scanners. AJR Am J Roentgenol. 2012; 198(5):1180-1187. |
Observational-Dx |
78 patients |
To evaluate the efficiency and reproducibility of a contrast-enhanced 3D MRA protocol, using the provocative arm position on 1.5- and 3-T MRI scanners, and to determine the frequency and distribution of vascular compression and vascular complications in the thoracic outlet. |
A venous component, which presented with mainly venous symptoms and findings, was confirmed in 85% of the subjects. An arterial component, which presented with clinical symptoms and findings of vascular TOS syndrome, was seen in 82% of the subjects. The vascular component of TOS, which presented with mainly neurogenic or indeterminate symptoms or findings, was excluded in 61% of the subjects. |
3 |
| 20. Gharagozloo F, Meyer M, Tempesta B, Strother E, Margolis M, Neville R. Proposed pathogenesis of Paget-Schroetter disease: impingement of the subclavian vein by a congenitally malformed bony tubercle on the first rib. J Clin Pathol. 2012; 65(3):262-266. |
Review/Other-Dx |
15 patients with Paget-Schroetter Disease |
To study and compare the anatomical and clinical pathology of first ribs in patients with Paget-Schroetter Disease with first ribs in patients without the disease. |
15 first ribs were from patients with Paget-Schroetter Disease and 7 normal first ribs were from human cadavers. In all patients (100%) with Paget-Schroetter Disease there was a bony tubercle that corresponded to the area of the subclavian vein groove in the normal ribs. In all controls (100%), there was a normal subclavian groove without the presence of a tubercle. On preoperative venograms in patients with Paget-Schroetter Disease, the tubercle accounted for an extrinsic protuberance that compressed the subclavian vein (100%). Intraoperatively, the abnormal bony tubercle accounted for the extrinsic compression of the subclavian vein in all (100%) patients with Paget-Schroetter Disease Venograms of the upper extremity obtained after first rib resection showed the disappearance of the extrinsic compression on the subclavian vein (100%) and a patent subclavian vein with elevation of the arm in all patients. |
4 |
| 21. Viertel VG, Intrapiromkul J, Maluf F, et al. Cervical ribs: a common variant overlooked in CT imaging. AJNR Am J Neuroradiol. 2012; 33(11):2191-2194. |
Review/Other-Dx |
3,404 consecutive patients |
To investigate how often cervical ribs are present on cervical spine CT scans to determine the incidence in humans and the percentage of reported cervical ribs. |
Cervical ribs were found in 2.0% (67/3,404) of the population. Of the 67 patients with cervical ribs, 27 (40.3%) had bilateral ribs. The prevalence of cervical ribs in women was twice that in men, 2.8% (39/1,414) vs 1.4% (28/1,990). Although African Americans accounted for 50.1% (1,706/3,404) and whites, 41.2% (1,402/3,404) of the patient population, African Americans were 70.1% (47/67) of patients with cervical ribs, whereas whites were 26.9% (18/67). Radiologists commented on 25.5% (24/94) of the cervical ribs in 25.4% (27/67) of patients. |
4 |
| 22. Gu R, Kang MY, Gao ZL, Zhao JW, Wang JC. Differential diagnosis of cervical radiculopathy and superior pulmonary sulcus tumor. Chin Med J. 125(15):2755-7, 2012 Aug. |
Review/Other-Dx |
10 patients |
To investigate the differential diagnosis methods of cervical radiculopathy and superior pulmonary sulcus tumor. |
Superior pulmonary sulcus tumor patients have shorter mean history and fewer complaints of neck pain or limitation of neck movement. Physical examination showed almost normal cervical spine range of motion. Spurling’s neck compression test was negative in all patients. Anteroposterior cervical radiographs showed the lack of pulmonary air at the top of the affected lung in all cases and first rib encroachment in one case. The diagnosis of superior pulmonary sulcus tumor can be further confirmed by CT and MRI. |
4 |
| 23. Chang KZ, Likes K, Davis K, Demos J, Freischlag JA. The significance of cervical ribs in thoracic outlet syndrome. J Vasc Surg. 57(3):771-5, 2013 Mar. |
Review/Other-Tx |
20 patients |
To review operative experience in patients with thoracic outlet syndrome (TOS) resulting from cervical ribs causing clinical symptoms. |
23 cervical rib resections were performed on 20 patients, three of whom had bilateral cervical ribs resected during separate operations. Seven patients presented with subclavian artery thrombosis. Three of seven patients had subclavian artery aneurysms and underwent cervical rib resection through a supraclavicular approach to facilitate subclavian artery bypass. Five patients presented with an ischemic upper extremity without thrombosis and underwent transaxillary first rib and cervical rib resection. Three patients presented with subclavian vein thrombosis; two of the three patients underwent balloon dilation 2 weeks postoperatively for stenosis. Additionally, five patients presented with neurogenic TOS evidenced by pain, numbness, and weakness without vascular compromise in the affected arm. Cervical ribs with bony fusion to the first rib were found in 17 of 23 cases (74%). |
4 |
| 24. Balakrishnan A, Coates P, Parry CA. Thoracic outlet syndrome caused by pseudoarticulation of a cervical rib with the scalene tubercle of the first rib. J Vasc Surg. 2012;55(5):1495. |
Review/Other-Dx |
1 patient |
A 20-year-old man presented with a bony lump above the left clavicle associated with upper limb pain, numbness, and tingling is reported. |
A lateral neck radiograph identified an unusual bony contour anteriorly at C7/T1 suggesting a cervical rib (A). Duplex ultrasound scan showed widely patent left axillary and subclavian arteries with the arm adducted but severe compression of the subclavian artery on abducting the arm to 90°. A subsequent CTA confirmed bilateral cervical ribs; the left articulating with an extended left transverse process of the seventh cervical vertebra, extending inferiorly to fuse with the first rib (B and C/Cover). |
4 |
| 25. Kirschbaum A, Palade E, Csatari Z, Passlick B. Venous thoracic outlet syndrome caused by a congenital rib malformation. Interact Cardiovasc Thorac Surg. 2012;15(2):328-329. |
Review/Other-Tx |
1 patient |
To describe the first reported case worldwide of a venous compression syndrome caused by a congenital malformation of the 1st and 2nd ribs. |
Treatment by transaxillary partial rib resection was necessary and a very good postoperative result was achieved. |
4 |
| 26. O'Brien PJ, Ramasunder S, Cox MW. Venous thoracic outlet syndrome secondary to first rib osteochondroma in a pediatric patient. J Vasc Surg. 2011;53(3):811-813. |
Review/Other-Dx |
1 patient |
To report the very rare case of a pediatric patient with venous thoracic outlet syndrome due to an osteochondroma of the first rib. |
No results stated. |
4 |
| 27. Davis GA, Knight SR. Pancoast tumors. Neurosurg Clin N Am. 19(4):545-57, v-vi, 2008 Oct. |
Review/Other-Tx |
N/A |
To examine a protocol that incorporates induction chemoradiation, surgical resection of the lung tumor by a thoracic surgeon, and neurolysis and preservation of the brachial plexus by a neurosurgeon. |
Improved survival outcome, especially in patients demonstrating a pathologic complete response, with preservation of hand function, supports the authors hypothesis that involved brachial plexus does not need resection in these patients. |
4 |
| 28. Demondion X, Vidal C, Herbinet P, Gautier C, Duquesnoy B, Cotten A. Ultrasonographic assessment of arterial cross-sectional area in the thoracic outlet on postural maneuvers measured with power Doppler ultrasonography in both asymptomatic and symptomatic populations. J Ultrasound Med. 2006; 25(2):217-224. |
Observational-Dx |
44 volunteers and 28 patients |
To evaluate the feasibility and potential usefulness of power Doppler US in the assessment of changes in arterial cross-sectional area in the thoracic outlet during upper limb elevation. |
No significant arterial stenosis was shown in the interscalene triangle and in the retropectoralis minor space of the volunteers and patients. A significant difference (P<.01) in stenosis between volunteers and patients was seen for all degrees of abduction in the costoclavicular space. The 130 degrees hyperabduction maneuver appeared to be the most discriminating postural maneuver. Seven patients assessed with MRI did not have any arterial stenosis on MRIs, whereas an appreciable degree of arterial stenosis was shown with US. |
3 |
| 29. Demondion X, Herbinet P, Boutry N, Fontaine C, Francke JP, Cotten A. Sonographic mapping of the normal brachial plexus. AJNR Am J Neuroradiol. 24(7):1303-9, 2003 Aug. |
Review/Other-Dx |
12 healthy adult volunteers |
To demonstrate that mapping of the brachial plexus may be performed by means of US. |
A satisfactory US examination was performed in 10/12 volunteers, leading to a good association with anatomic sections. Two volunteers were excluded from the study because a clear depiction of the brachial plexus was difficult owing to a short neck and low echogenicity at examination. The association between US images and anatomic sections allowed the authors to map the brachial plexus. The subclavian and deep cervical arteries were useful landmarks for this mapping. The eighth cervical nerve root and the first thoracic nerve root were the most difficult part of the brachial plexus to depict because of their deep location. |
4 |
| 30. Torriani M, Gupta R, Donahue DM. Sonographically guided anesthetic injection of anterior scalene muscle for investigation of neurogenic thoracic outlet syndrome. Skeletal Radiol. 2009; 38(11):1083-1087. |
Review/Other-Tx |
26 subjects |
To describe the technique and complications of sonographically guided anesthetic injection of the anterior scalene muscle in patients being investigated for neurogenic TOS. |
26 subjects with suspected neurogenic TOS underwent 29 injections (3 subjects received bilateral injections). Technical success was achieved in all procedures. The mean duration of the procedure was 30 minutes, and there were no cases of intravascular needle placement or neurogenic pain during the injection. No major complications occurred. Temporary symptoms of partial brachial plexus block occurred after 9 injections (9/29, 31%), and a temporary complete brachial plexus block occurred after one injection (1/29, 3%). |
4 |
| 31. Chang KZ, Likes K, Demos J, Black JH 3rd, Freischlag JA. Routine venography following transaxillary first rib resection and scalenectomy (FRRS) for chronic subclavian vein thrombosis ensures excellent outcomes and vein patency. Vasc Endovascular Surg. 46(1):15-20, 2012 Jan. |
Observational-Tx |
84 patients |
To evaluate the long-term outcomes of patients who underwent first rib resection and scalenectomy (FRRS) for effort thrombosis, who presented to Johns Hopkins Medical Institutions, between 2003 and 2009, and were treated according to our protocol. |
Of the 85 patients, 21 patients had patent veins, 47 patients had stenotic veins, and 16 patients had chronically occluded veins. In follow-up, symptomatic restenosis was seen in 3 patients and those veins were redilated. Two other patients had late occlusions at 23 and 63 months and received anticoagulation and redilatation, respectively. Using venography to guide postoperative management, 79 of 84 patients had patent veins many years postoperatively. Long-term patency, as seen by duplex scan, was achieved in nearly all patients using this protocol. |
2 |
| 32. Zurkiya O, Donahue DM, Walker TG, Ganguli S. Safety and Efficacy of Catheter-Directed Therapies as a Supplement to Surgical Decompression in Venous Thoracic Outlet Syndrome. AJR Am J Roentgenol. 210(2):W80-W85, 2018 Feb. |
Observational-Tx |
81 patients |
To evaluate the role of endovascular therapy in the management of venous thoracic outlet syndrome (TOS), with an emphasis on its role after surgical decompression. |
Of the 81 patients included in the study, 73 (90%) had angiographic evidence of venous TOS; 41 of these 73 patients (56%) underwent endovascular venous intervention (e.g., thrombolysis or angioplasty before surgical) decompression. A total of 67 patients (67/73; 92%) with venous TOS underwent surgical decompression, with 56 of these (56/73; 77%) undergoing postoperative venography. Of these 56 patients who underwent postoperative venography,48 (86%) required venoplasty, four had normal-appearing subclavian veins (7%) and had no intervention, and four of 48 (8%) had chronic total venous occlusions that could not be recanalized. Only four of the 48 of the patients (8%) who underwent postdecompression venoplasty required subsequent repeat venography and intervention for management of persistent or recurrent symptoms, whereas all others (44/48; 92%) remained symptom free on clinical followup. No complications were identified that were related to the endovascular interventions. |
2 |
| 33. Kim TI, Sarac TP, Orion KC. Intravascular Ultrasound in Venous Thoracic Outlet Syndrome. Ann Vasc Surg. 54:118-122, 2019 Jan. |
Observational-Dx |
14 patients |
To evaluate the use of intravascular ultrasound (IVUS) in the treatment of venous thoracic outlet syndrome (vTOS) patients who have been surgically decompressed with first rib resection with anterior scalenectomy (FRRS). |
During the 2-year period, 14 patients underwent 24 upper extremity venograms performed after surgical decompression for venous thoracic outlet syndrome (vTOS), 18 of which included intravascular ultrasound (IVUS). Of the 18 cases with IVUS, 5 (27.8%) stenoses >50% were detected by IVUS, which were not apparent on venography, leading to intervention. IVUS detected a greater degree of stenosis than venography. Seven patients required repeat venograms. Overall, IVUS detected significant venous stenosis in 94.4% of patients compared with 66.7% of patients with venography after first rib resection with anterior scalenectomy (FRRS) for vTOS. |
3 |
| 34. Poretti D, Lanza E, Sconfienza LM, et al. Simultaneous bilateral magnetic resonance angiography to evaluate thoracic outlet syndrome. Radiol Med (Torino). 120(5):407-12, 2015 May. |
Observational-Dx |
38 patients |
To present a new magnetic resonance angiography (MRA) protocol for the evaluation of thoracic outlet syndrome (TOS) that allows for a separate assessment of veins and arteries while using a single, simultaneous and bilateral (SB-MRA) single contrast injection, valid for both abduction and adduction acquisitions. |
Seventeen (45 %) patients were diagnosed with predominant venous TOS (VTOS), nine (24 %) with predominant arterial TOS (ATOS) and 12 (32 %) had an indeterminate or nonvascular condition. Group A radiologists identified significantly more VTOS than group B (p = 0.049). Interobserver agreement was very high. |
3 |
| 35. Lim RP, Bruno M, Rosenkrantz AB, et al. Comparison of blood pool and extracellular gadolinium chelate for functional MR evaluation of vascular thoracic outlet syndrome. Eur J Radiol. 83(7):1209-1215, 2014 Jul. |
Observational-Dx |
31 patients |
To compare performance of single-injection blood pool agent (gadofosveset trisodium, BPA)against dual-injection extracellular contrast (gadopentetate dimeglumine, ECA) for MR angiography (MRA)/equilibrium phase venography (MRV) in assessment of suspected vascular thoracic outlet syndrome (TOS). |
Median image quality was diagnostic or better (score =3) for ECA and BPA at all time points, with BPA image quality superior at abduction late (BPA 4.5, ECA 4, p = 0.042) and ECA image quality superior at adduction-early (BPA 4.5; ECA 4.0, p = 0.018). High qualitative vessel contrast (mean score =3) was observed at all time points with both BPA and ECA, with superior BPA vessel contrast at abduction-late (BPA 3.97 ± 0.12; ECA 3.73 ± 0.26, p = 0.007) and ECA at adduction-early (BPA 3.42 ± 0.52; ECA 3.96 ± 0.14, p < 0.001). Readers readily identi?ed arterial and venous pathology with BPA, similar to ECA examinations. |
2 |
| 36. Charon JP, Milne W, Sheppard DG, Houston JG. Evaluation of MR angiographic technique in the assessment of thoracic outlet syndrome. Clin Radiol. 2004; 59(7):588-595. |
Observational-Dx |
55 consecutive examinations in 51 patients |
To evaluate 2D TOF and 3D contrast-enhanced MRA techniques in the assessment of patients with suspected TOS of vascular origin. |
Images were sub-optimal in 53% 2D TOF and 10% 3D contrast-enhanced MRA examinations. 3D contrast-enhanced MRA offered vessel coverage from the aortic arch to the distal axilliary arteries, whereas, 2D TOF sequences gave more limited coverage. 8 patients were found to have significant impingement (n = 7) or stenosis (n = 1) of the subclavian artery attributable to TOS. 3D contrast-enhanced MRA also demonstrated other relevant significant stenoses not attributable to TOS (n = 5). All cases of impingement were either seen only, or more prominently, on sequences with the arms abducted. Reformatting the 3D contrast-enhanced MRA studies demonstrated the cause of impingement. |
3 |
| 37. Gillard J, Perez-Cousin M, Hachulla E, et al. Diagnosing thoracic outlet syndrome: contribution of provocative tests, ultrasonography, electrophysiology, and helical computed tomography in 48 patients. Joint Bone Spine. 2001; 68(5):416-424. |
Observational-Dx |
48 patients |
To evaluate the diagnostic usefulness of provocative tests, Doppler US, electrophysiological investigations, and helical CTA in TOS. |
Provocative tests had mean sensitivity and specificity values of 72% and 53%, respectively, with better values for the Adson test ([PPV, 85%), the hyperabduction test (PPV, 92%), and the Wright test. Using several tests in combination improved specificity. Doppler US visualized vascular parietal abnormalities and confirmed the diagnosis in patients with at least 5 positive provocative tests. Electrophysiological studies were useful mainly for the differential diagnosis or for detecting concomitant abnormalities. Although helical CTA provided accurate information on the location and mechanism of vascular compression, the usefulness of this investigation for establishing the diagnosis of TOS and for obtaining pre-therapeutic information remains unclear. |
3 |
| 38. Stapleton C, Herrington L, George K. Sonographic evaluation of the subclavian artery during thoracic outlet syndrome shoulder manoeuvres. Man Ther. 2009; 14(1):19-27. |
Review/Other-Dx |
10 male and 21 female healthy volunteers |
To establish normative vascular responses in the subclavian artery (i.e., arterial diameter and peak systolic blood flow velocity to various arm positions, and determine the incidence of abnormal physiological responses. |
Alpha level was set at P=0.01. Significant decreases (P=0.008) in peak systolic blood flow velocity were recorded from 120 degrees, 90 degrees, and 45 degrees abduction (92+/-10, 89+/-11 and 88+/-14 cm s(-1), respectively) to 180 degrees abduction (mean+/-95% CI: 52+/-16 cm s(-1)). Similarly, post-hoc comparisons revealed a significant decrease (P=0.008) in peak systolic blood flow velocity from 120 degrees abduction (94+/-14 cm s(-1)) to 120 degrees abduction with 30 degrees horizontal extension and 90 degrees ER (69+/-12 cm s(-1)). Complete lack of blood flow was demonstrated by 6 subjects and 2 subjects at end of range abduction and combined end of range external rotation and horizontal extension, respectively. The heterogeneous response of asymptomatic individuals with no past history of TOS symptoms raises uncertainty of the validity of positive test responses from extreme arm positions. |
4 |
| 39. Molina JE, Hunter DW, Dietz CA. Protocols for Paget-Schroetter syndrome and late treatment of chronic subclavian vein obstruction. Ann Thorac Surg. 2009; 87(2):416-422. |
Observational-Tx |
126 Paget-Schroetter syndrome patients (group I) 81 patients (group II) |
To examine protocols for Paget-Schroetter syndrome and late treatment of chronic subclavian vein obstruction. |
The acute emergency care resulted in a 100% long-term patency rate in group I, with no sequelae. The patency rate in group II was 100% as well, but in 74% a long vein patch, endovascular stents, or homograft implants were used. |
3 |
| 40. Wadhwani R, Chaubal N, Sukthankar R, Shroff M, Agarwala S. Color Doppler and duplex sonography in 5 patients with thoracic outlet syndrome. J Ultrasound Med. 2001; 20(7):795-801. |
Review/Other-Dx |
5 patients |
To evaluate the use of color Doppler US in the diagnosis of TOS. |
Significant changes, (i.e., stages of increased velocities, preocclusion, and occlusion) in the subclavian artery in varying degrees of abduction, were noted in 4/5 cases. Blunted flow in the axillary artery (4 patients) and a rebound increase in velocities on release of abduction were noted in 3 patients. These changes suggested that significant narrowing was causing symptoms. |
4 |
| 41. Hasanadka R, Towne JB, Seabrook GR, Brown KR, Lewis BD, Foley WD. Computed tomography angiography to evaluate thoracic outlet neurovascular compression. Vasc Endovascular Surg. 2007; 41(4):316-321. |
Observational-Dx |
21 patients |
To evaluate the efficacy of CTA with upper extremity hyperabduction to diagnose TOS. |
5/6 CTAs were positive. The sixth CT was deemed to be an incomplete study. With mean follow-up of 9.4 months, 95% (n = 19) of patients with a positive hyperabduction test on physical examination were free of symptoms postoperatively. All patients with a positive CTA, with their neurovascular compression localized to the thoracic outlet, had successful operative decompression. CTA with abduction of the arm can be used as an adjunct to confirm the diagnosis of neurovascular compression and then predict successful operative decompression. |
4 |
| 42. Takei N, Miyoshi M, Kabasawa H. Noncontrast MR angiography for supraaortic arteries using inflow enhanced inversion recovery fast spin echo imaging. J Magn Reson Imaging. 2012; 35(4):957-962. |
Review/Other-Dx |
10 healthy volunteers |
To depict supraaortic arteries using 3D fast spin echo combined with slab selective inversion recovery for noncontrast MRA in healthy volunteers, and to investigate the property of the inflow enhanced inversion recovery-fast spin echo for background suppression and inflow effects. |
Inflow enhanced inversion recovery-fast spin echo images showed good visualization of the supraaortic arteries and allowed separation of arteries from veins without image subtraction. The proposed method demonstrated that a high contrast between arteries and background tissues can be acquired with various inversion times, which was in good agreement with the simulation. An inversion time over 1600 msec was favorable in terms of background suppression, arterial signal intensity, and inflow effects. |
4 |
| 43. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
