TOS UK (Thoracic Outlet Syndrome, United Kingdom): A Retrospective Review of Practice.

Shalan, Ahmed; El-Basty, Ahmed; Al-Saadi, Nina; Popplewell, Matthew; Wall, Michael; Hobbs, Simon; Pherwani, Arun; Fligelstone, Louis; Garnham, Andrew; Smith, Frank C.T

Abstract

Thoracic outlet syndrome (TOS) is caused by compression of the neurovascular bundle at the thoracic outlet which often poses a diagnostic challenge. Patient management is often based on surgeon choice and experience. This study aims to describe practices relating to the diagnosis and management of TOS in the UK over a 1-year period. This multicentre, retrospective UK study included data from 16 vascular centres, analysing surgical management and postoperative outcomes of patients treated for TOS in 2019. Outcomes were evaluated by TOS type: neurogenic (nTOS), venous (vTOS), or arterial (aTOS). Data on 133 patients from 16 units were collected over a 1-year period. Most patients were female (87/133; 65%). Surgeries addressed neurogenic TOS (53/133; 40%), venous TOS (48/133; 36%), and arterial TOS (32/133; 24%), with TOS type unspecified in 2 patients. Five imaging modalities were used for diagnosis. Surgical approaches included supraclavicular (90/133; 68%), transaxillary (23/133; 17%), infraclavicular (13/133; 10%), paraclavicular (6/133; 5%), and thoracoscopic (1/133; <1%). Pleural injury was the most reported complication (16/133; 12%). Most patients with pleural injury were managed conservatively, with only one-quarter requiring the insertion of a chest drain (4/16; 25%). Most patients (119/133; 89%) had symptom resolution, lower in neurogenic TOS compared to arterial and venous (p<0.05). There is considerable variability in the diagnosis and management of patients with TOS across vascular centres in the UK. This study supports the development of a national registry and the creation of best practice guidelines in the future. [Abstract copyright: Copyright © 2025. Published by Elsevier Inc.]

Citation

Shalan, A., El-Basty, A., Al-Saadi, N., Popplewell, M., Wall, M., Hobbs, S., Pherwani, A., Fligelstone, L., Garnham, A., & Smith, F. C. (2025). TOS UK (Thoracic Outlet Syndrome, United Kingdom): A Retrospective Review of Practice. Annals of Vascular Surgery, 114, 74-82. https://doi.org/10.1016/j.avsg.2025.01.031

• Journal Article Type: Article
• Acceptance Date: Jan 16, 2025
• Online Publication Date: Jan 27, 2025
• Publication Date: 2025-05
• Deposit Date: Apr 16, 2025
• Journal: Annals of vascular surgery
• Print ISSN: 0890-5096
• Electronic ISSN: 1615-5947
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 114
• Pages: 74-82
• DOI: https://doi.org/10.1016/j.avsg.2025.01.031
• Keywords: Thoracic outlet syndrome, Thoracic outlet decompression
• Public URL: https://keele-repository.worktribe.com/output/1076315
• Publisher URL: https://www.sciencedirect.com/science/article/abs/pii/S0890509625000603?via%3Dihub