Chapter 124 - Surgical decompression of the thoracic outlet

Question 1

Current recommendation for surgical decompression after vTOS successful thrombolysis wait time

Answer 1

no wait at all

proceed in same hospital admission

Question 2

arterial TOS reconstruction different conduit 5 year patency

Answer 2

PTFE 96%
Dacron 84%
GSV 65%

small numbers so no hard rule on recommendation

Question 3

Infraclavicular approach for vTOS steps

Answer 3

1) transverse incision below clavicle
2) partial resect anterior half of first rib and subclavius tendon
3) division both anterior scalene tendon and part of middle scalene muscle at level of subclavian artery
4) vein control and patch