Rib-sparing subclavian vein decompression in venous thoracic outlet syndrome

Objective

Venous thoracic outlet syndrome (VTOS), a compression syndrome of the subclavian vein at the costoclavicular junction, is commonly treated with first rib resection. This invasive procedure carries a risk of serious complications. The purpose of this single-center cross-sectional study was to evaluate the long-term outcome of non-bony decompression by resection of the subclavius muscle and tendon and to provide a detailed description of the procedure.

Methods

Patients who underwent rib-sparing decompression for VTOS between July 2014 and September 2023 were analyzed using clinical and radiological examinations. Patient-reported measures were used to assess functional disability and residual symptoms (Disabilities of the Arm, Shoulder and Hand—DASH) and disease-specific quality of life and symptoms (VEINES-QOL/SYM).

Results

Ten patients were included in the study. Seven were treated for Paget-Schroetter syndrome and three for McCleery syndrome. At a mean follow-up of 45.4 (standard deviation [SD] 31.0) months, all patients reported significant resolution of initial symptoms with patent vasculature on Doppler ultrasonography. All patients had a Villalta post-thrombotic syndrome score of <4, indicating the absence of post-thrombotic syndrome. A mean DASH score of 3.8 (SD 5.3) indicated minimal functional disability. Patients reported minimal overall impact on their quality of life, as reflected by a mean VEINES-QOL score of 92.6 (SD 8.9), and low severity of venous symptoms, as indicated by a mean VEINES-SYM score of 92.7 (SD 9.8).

Conclusion

Our analysis suggests that non-bony decompression with resection of the subclavius muscle and tendon is a safe and effective intervention for the definitive treatment of VTOS that is less invasive than first rib resection.