ABSTRACT
Resumen El síndrome del opérculo torácico se refiere a una serie de signos y síntomas que se producen por la compresión del paquete vásculo-nervioso en la unión costo-clavicular. El síndrome de Paget-Schroetter (SPS) se define como la trombosis primaria, espontánea o de esfuerzo de la vena subclavia. Las vías de abordaje quirúrgicas tradicionales utilizadas para descomprimir el opérculo torácico son la trans axilar y las claviculares (supra e infra). El objetivo del estudio fue describir nuestra experiencia en la resección de la primera costilla por videotoracoscopía (VATS). Este es un estudio descriptivo observacional utilizando una base de datos prospectiva con análisis retrospectivo desde enero de 2017 a marzo de 2020. Se incluyeron 9 pacientes con diagnóstico de SPS en los que se resecó la primera costilla por VATS. En un paciente el procedimiento fue bilateral por presentar trombosis espontánea en ambas venas subclavias. De los 9, 6 eran mujeres. La edad media fue de 30.7 ± 10.7 años. La estadía hospitalaria media fue de 3.1 ± 0.5 días. Uno fue re-operado por hemotórax. No se detectaron recurrencias en el seguimiento a mediano-largo plazo. La resección de la primera costilla por VATS es un procedimiento seguro y factible. La misma, a diferencia de los abordajes tradicionales, puede ser resecada bajo visión directa de todos los elementos del opérculo torácico. Sin embargo, esta técnica requiere un manejo avanzado en cirugía toracoscópica.
Abstract Thoracic outlet syndrome (TOS) refers to a number of signs and symptoms that arise from compression of the neurovascular bundle at the costoclavicular junction. Paget-Schroetter syndrome is defined as the primary, spontaneous or effort thrombosis of the subclavian vein. The supraclavicular and trans-axillary approaches are currently the most commonly used for first rib resection. The aim of this article was to describe our experience in a minimally invasive approach (VATS) of first rib resection for primary venous thoracic outlet and the associated outcomes. This is a descriptive observational study using a retrospective analysis of a prospective database from January 2017 to March 2020. Nine patients underwent video thoracoscopic first rib resection due to PagetSchroetter syndrome (one bilateral procedure). Ten thoracoscopic first rib resections were performed. There were 6 female and 3 male patients, with a mean age of 30.7 ± 10.7 years. The mean length of hospital stay was 3.1 ± 0.5 days. No complications were recorded intraoperatively. One patient had to be re-operated because of hemothorax. There were no recurrences in a follow-up of at least 12 months. VATS resection of the first rib is a safe and feasible procedure and can be performed under direct vision of thoracic outlet elements. However, the technique requires experience with thoracoscopic surgery. The outcomes associated with our technique are comparable with the outcomes related to other current standards of care.
Subject(s)
Humans , Male , Female , Adult , Young Adult , Upper Extremity Deep Vein Thrombosis/surgery , Upper Extremity Deep Vein Thrombosis/diagnostic imaging , Ribs/surgery , Ribs/diagnostic imaging , Thoracoscopy , Retrospective Studies , Treatment OutcomeABSTRACT
A trombose venosa subclávio-axilar é um evento trombótico pouco frequente, relacionado a esforço físico excessivo com o membro superior dominante. Ocorre predominantemente em indivíduos jovens do sexo masculino, e apresenta-se com quadro agudo de trombose venosa profunda, devendo ser lembrada no diagnóstico diferencial de patologias que causam dor e edema em membro superior. O diagnóstico e a terapêutica precoces têm fundamental importância para minimizar a morbidade desta condição
The axillary-subclavian vein thrombosis is an infrequent thrombotic event, related to excessive physical effort with the dominant upper extremity. It happens predominantly in young men and appears as deep vein thrombosis that must be reminded on the differential diagnosis of pathologies that cause pain and swelling in the upper extremity. The early diagnosis and therapy have great importance to minimize the morbidity of this condition
Subject(s)
Humans , Male , Young Adult , Physical Exertion , Upper Extremity Deep Vein Thrombosis/diagnosis , Upper Extremity Deep Vein Thrombosis/therapy , Upper Extremity , Anticoagulants/therapeutic use , Diagnosis, Differential , Diagnostic Imaging , Phlebography , Thrombolytic Therapy , Venous Thrombosis/diagnosisABSTRACT
Paget-Schroetter syndrome is synonymous with spontaneous or effort-induced thrombosis of the axillosubclavian vein that is characterized by swelling and pain on upper extremity. Though axillosubclavian thrombosis represents only 1 - 2%, its frequency of diagnosis has increased over the past years due to improvement of ultrasonography. Although the cause of catheter and drug-related cases is clear, several studies have invested the etiology of Paget- Schroetter syndrome, a condition more commonly seen in the young and otherwise healthy individual. Factors often cited include compression of the vein by the anatomic structure, stress, or excessive effort to the extremity, and repetitive shoulder-arm motion. In the view of treatment, thrombolysis by direct infusion of urokinase has proven to be superior to surgical thrombectomy and is now treatment of choice. We successfully treated a 30-year-old man who suffered from swelling and pain on the right upper extremity by using direct urokinase infusion on thrombosis of subclavian vein. This is very rare disease in plastic and reconstructive surgery, thus diagnosis will seldom be made on clinical evaluation. It should be included in the differential diagnosis of upper extremity swelling compared with lymphedema.
Subject(s)
Adult , Humans , Catheters , Diagnosis , Diagnosis, Differential , Extremities , Lymphedema , Plastics , Rare Diseases , Subclavian Vein , Thrombectomy , Thrombosis , Ultrasonography , Upper Extremity , Upper Extremity Deep Vein Thrombosis , Urokinase-Type Plasminogen Activator , VeinsABSTRACT
Spontaneous thrombosis of the subclavian vein, termed "effort thrombosis" or the Paget-Schroetter Syndrome, has long been considered a primary thrombotic process, but recent experience suggests that it may commonly result from repeated mechanical compression. This syndrome is unusual and is frequently considered inconsequential compared with thrombosis of the iliac or femoral vein. However, pulmonary embolism has been documented in up to 15% of patients with subclavian thrombosis. Many patients with this disorder are offlicted by disabling symptoms of upper extremity venous congestion. It is now recognized that the morbidity of this condition is significant and its traditional treatment needs serious reconsideration. Presumed to be a primary thrombotic disorder, its treatment has traditionally consisted of arm elevation and anticoagulation. Increased awareness of the pathophysiology of this symdrome can allow timely, improved diagnostic screening and use of specific surgical intervention to relieve the venous consequences. During the 44 months we have treated 5 patients with the thrombosis of subclavian vein. There were two men and three women with an average of 50 years(range from 40~61 years). And all patients presented with pain, swelling, and cyanosis of the upper extremity. Venous congestion worsened especially with abduction of the arm. Three of five patients were originally treated with arm elevation and anticoagulation; two also underwent surgical intervention.