Chapter 123 - Venous TOS

Question 1

Rate of contralateral vein narrowing in vTOS

Answer 1

56-80%

Question 2

Rate of bilateral thrombosis in vTOS

Answer 2

2-15%

Question 3

McCleery syndrome first described

Answer 3

1951 McCleery

Question 4

McCleery syndrome definition

Answer 4

intermittent obstruction of subclavian evin without thrombosis

Question 5

McCleery syndrome symptoms

Answer 5

1) blue discoloration of arm
2) superficial vein distention
3) swelling

Question 6

Secondary UE DVT

Answer 6

1) CVC
2) pacemaker wires
3) nephrotic syndrome
4) mediastinal tumours
5) malignancy
6) local surgery or trauma
7) hypercoagulable state
8) renal failure with dialysis

Question 7

Rate of CVC causing DVT

Answer 7

5%

Question 8

Rate of PE with UE DVT (all cause not just vTOS)

Answer 8

15-25%

Question 9

With PM use, risk factors that increase venous stasis

Answer 9

1) number of leads
2) previous temp PM
3) EF < 40%
4) infection

Question 10

Pathophysiology of secondary UE DVT

Answer 10

Vein wall damage

Question 11

epidemiology of vTOS

Answer 11

32 years old
usually 20-40’s
equal gender ratio

Question 12

First rib bypass venous collaterals

Answer 12

pattern of collateral developing around anterior chest wall, shoulder and neck

Question 13

Rate of venous gangrene due to vTOS

Answer 13

never reported

usually secondary and has to do with malignancy

Question 14

Duplex challenges in the upper extremity

Answer 14

1) clavicle

2) lung

Question 15

Duplex sensitivity and spe on detecting UE DVT

Answer 15

sen 81-100%
spe 82-100%

only if color duplex used on top of Bmode

Question 16

Positioning of arm in venogram for vTOS

Answer 16

90 and 180 degrees

Question 17

vTOS patients classified based on chronicity

Answer 17

1) acute subclavian-axillary vein thrombosis
2) chronic or recurrent subclavian-axillary vein thrombosis
3) high grade symptomatic subclavian-axially vein thrombosis

Question 18

Anticoagulation effect on vTOS

Answer 18

40% has residual symptoms or limited recovery

Question 19

CVC -induced UE DVT

Answer 19

anticoagulation x 3 months after CVC removal

anticoagulation for the entire time that catheter is in place

Question 20

Patients with contraindication to anticoagulation with UE DVT

Answer 20

1) conservative mgnt (rate of PE is low)

2) SVC filter

Question 21

Success of urokinase in treated primary subclavian-axillary thrombosis

Answer 21

82%

Question 22

time frame of thrombolysis from onset of DVT

Answer 22

< 14 days good results

> 14 days still can do but poorer results

Question 23

benefit of preoperative thrombolysis before surgical decompression of UE DVT

Answer 23

not clear

surgery alone proves beneficial as well

Question 24

Risk factors for failing thrombolysis of UEDVT

Answer 24

1) overly aggressive balloon angioplasty in past

2) stenting in vein

Question 25

Post thrombolysis care in vTOS

Answer 25

1) if completion angio shows no external stenosis - 3-6 months anticoagulation
2) if completion angio shows persistent external compression - consider TOS decompression

Question 26

Rate of venous rethrombosis during waiting period between thrombolysis and TOS release

Answer 26

6-18%

Question 27

After vTOS thrombolysis and TOS release, veins reconstruction open vs endo key points

Answer 27

1) open increases morbidity

2) endo requires anticoagulation after so maybe better to wait

Question 28

Post vTOS repair care

Answer 28

physiotherapy x 6 weeks focusing on

1) ROM shoulder girdle
2) function and flexibility of upper cervical spine
3) strengthen scalene muscles
4) stretch trapezius, SCM, levator scapular and pec minor
5) resistance shoulder elevation exercise

Question 29

Causes of recurrence after vTOS rib resection

Answer 29

1) incomplete first rib removal

2) subclavius tendon incomplete resection