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Article Abstract
Objective: To evaluate the association between subclavian vein patency and health-related quality of life following supraclavicular thoracic outlet decompression among patients with venous thoracic outlet syndrome.
Methods: Patients who underwent supraclavicular thoracic outlet decompression (i.e. first thoracic rib resection, scalenectomy, and subclavian venolysis) were identified from a prospectively maintained database. Demography, perioperative venography, and catheter-directed interventions were recorded. The primary endpoints were subclavian vein patency and health-related quality of life following decompression. The association between subclavian vein patency and health-related quality of life was evaluated in unadjusted and logistic regression analyses.
Results: Among 1,032 patients with TOS who underwent surgery (2007-2021), 275 patients presented with venous thoracic outlet syndrome. Two-hundred and twenty-five patients (81.8%) underwent preoperative venography; 221 (98.2%) had completely or partially stenosed subclavian veins. Preoperative catheter-based interventions were performed among 166 patients (60.4%); stenosis remained in 130 patients (78.3%). Postoperatively, 216 patients (78.5%) underwent routine venography; improvement in stenosis was observed in 54 (25.0%). Additional catheter-based interventions were performed in 155 patients (56.4%) with improvement in stenosis observed in 131 patients (84.5%). At a median follow up of 279 days [IQR 95, 674], 94.0% of patients reported improvement in health-related quality of life. Improvement in subclavian vein patency was associated with improved health-related quality of life (adjusted odds ratio 2.19 [95%CI 1.12-4.28], p=0.021).
Conclusions: Subclavian vein patency is associated with improved health-related quality of life among patients with venous thoracic outlet syndrome. Effective venolysis during thoracic outlet decompression with perioperative catheter-directed intervention contributes most significantly to vein patency.
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| http://dx.doi.org/10.1016/j.jtcvs.2025.08.035 | DOI Listing |
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