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 Smith, Frank CT Garnham, Andrew
Shalan, Ahmed
El-Basty, Ahmed
Al-Saadi, Nina
Popplewell, Matthew
Wall, Michael
Hobbs, Simon
Pherwani, Arun
Fligelstone, Louis
Smith, Frank CT
Garnham, Andrew
Affiliation
The Dudley Group NHS Foundation Trust; University Hospital of Southampton NHS Foundation Trust; University Hospital of North Midlands NHS Foundation Trust et al
Other Contributors
Publication date
2025/05/01
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Collections
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Abstract
Background: 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. Methods: This multicenter retrospective UK study included data from 16 vascular centers, analyzing surgical management and postoperative outcomes of patients treated for TOS in 2019. Outcomes were evaluated by TOS type: neurogenic (nTOS), venous (vTOS), or arterial TOS (aTOS). Results: Data on 133 patients from 16 units were collected over a 1-year period. Most patients were female (87 of 133; 65%). Surgeries addressed nTOS (53 of 133; 40%), vTOS (48 of 133; 36%), and aTOS (32 of 133; 24%), with TOS type unspecified in 2 patients. Five imaging modalities were used for diagnosis. Surgical approaches included supraclavicular (90 of 133; 68%), transaxillary (23 of 133; 17%), infraclavicular (13 of 133; 10%), paraclavicular (6 of 133; 5%), and thoracoscopic (1 of 133; <1%). Pleural injury was the most reported complication (16 of 133; 12%). Most patients with pleural injury were managed conservatively, with only one-quarter requiring the insertion of a chest drain (4 of 16; 25%). Most patients (119 of 133; 89%) had symptom resolution, lower in nTOS compared to arterial and vTOS (P < 0.05). Conclusion: There is considerable variability in the diagnosis and management of patients with TOS across vascular centers in the UK. This study supports the development of a national registry and the creation of best practice guidelines in the future.
Citation
Shalan A, El-Basty A, Al-Saadi N, Popplewell M, Wall M, Hobbs S, Pherwani A, Fligelstone L, Smith FCT, Garnham A; TOS UK Study Collaborators. Thoracic Outlet Syndrome, United Kingdom: A Retrospective Review of Practice. Ann Vasc Surg. 2025 May;114:74-82. doi: 10.1016/j.avsg.2025.01.031. Epub 2025 Jan 27.