SIR 2024
Venous Interventions
Kieran Bhave, BA
Medical Student
Harvard Medical School
Financial relationships: Full list of relationships is listed on the CME information page.
Patrick Sutphin, MD, PhD (he/him/his)
Assistant Professor
Massachusetts General Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
Sanjeeva P. Kalva, MBBS, MD, RPVI, FSIR, FCIRSE, FACR (he/him/his)
Professor
Massachusetts General Hospital
Financial relationships: Full list of relationships is listed on the CME information page.
To evaluate the outcomes of percutaneous balloon angioplasty (PBA) for residual venous stenosis following surgical decompression for venous thoracic outlet syndrome (vTOS) and report the risk factors for developing recurrent venous stenosis post PBA.
Materials and Methods:
In this IRB-approved, single-center, retrospective study, 156 upper extremity venography studies in 149 unique patients (41% male, 59% female, average age of 31 with a range from 13-71 and a median of 30 years of age; 7 patients had both upper extremity venography studies), who had undergone surgical decompression followed by a diagnostic upper extremity venography within 8 weeks of surgery during 2000 and 2023 were included. Findings on post-operative venography and results of venous intervention were assessed. Post-PBA recurrent stenosis was diagnosed based on patient reported return of symptoms (pain, swelling, paresthesia) and subsequent venography findings.
Results:
Of 156 post-operative upper extremity venography studies, 21 showed patent venous circulation with no intervention indicated, with a residual venous stenosis/occlusion rate of 86.5% following surgical decompression. Eight patients had venous occlusion that could not be recanalized. 127 limbs (venous stenosis in 15, venous occlusion in 112) underwent successful PBA with adequate luminal diameter and blood flow noted on post-angioplasty venography. There were no complications related to PBA. 122/156 (78%) limbs had anticoagulation therapy after post-operative venography resumed. The 1-yr, 3-yr, and 5-yr primary patency rates following PBA were 86% (n=97/113), 85% (n=85/100), and 81% (n=60/74), respectively. Twenty (20/127, 15.7%) limbs had recurrence of symptoms with diagnostic venography confirming recurrent venous stenosis or occlusion. The average time to recurrence of symptoms was 346 days. The presence of thrombosis/and or stenosis outside the subclavian vein at the time of initial presentation (prior to surgical decompression) and the balloon size used for PBA did not statistically impact the rates of recurrent stenosis following PBA (p=.9063 and p=.9505 respectively). Similarly, the rates of recurrent stenosis following PBA were not affected by prior use of mechanical thrombectomy or thrombolysis or no intervention prior to first rib resection (p=0.3358).
Conclusion:
PBA within 8 weeks of surgical decompression is highly effective for treating residual venous stenosis and preventing recurrent venous stenosis following surgery for vTOS.