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Fereydooni A, Sgroi MD. Management of thoracic outlet syndrome in patients with hemodialysis access. Semin Vasc Surg 2024; 37:50-56. [PMID: 38704184 DOI: 10.1053/j.semvascsurg.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 05/06/2024]
Abstract
Patients with threatened arteriovenous access are often found to have central venous stenoses at the ipsilateral costoclavicular junction, which may be resistant to endovascular intervention. Stenoses in this location may not resolve unless surgical decompression of thoracic outlet is performed to relieve the extrinsic compression on the subclavian vein. The authors reviewed the management of dialysis patients with central venous lesions at the thoracic outlet, as well as the role of surgical decompression with first-rib resection or claviculectomy for salvage of threatened, ipsilateral dialysis access.
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Affiliation(s)
- Arash Fereydooni
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, Suite CJ350, MC5639, Palo Alto, CA, 94304
| | - Michael David Sgroi
- Division of Vascular and Endovascular Surgery, Department of Surgery, Stanford University School of Medicine, 780 Welch Road, Suite CJ350, MC5639, Palo Alto, CA, 94304.
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Garraud T, Pomares G, Daley P, Menu P, Dauty M, Fouasson-Chailloux A. Thoracic Outlet Syndrome in Sport: A Systematic Review. Front Physiol 2022; 13:838014. [PMID: 35755427 PMCID: PMC9214221 DOI: 10.3389/fphys.2022.838014] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Thoracic outlet syndrome (TOS) is a rare and heterogeneous syndrome secondary to a compression of the neurovascular bundle in the thoracic outlet area. Muscle hypertrophy is recognized to induce vascular or neurogenic compression, especially in sports involving upper-arm solicitation. Athletes represent a distinctive population because of a specific management due to an ambitious objective, which is returning to high-level competition. We evaluated the scientific literature available for the management of TOS in athletes. Article research extended to March 2021 without other restriction concerning the date of articles publication. The search was performed independently by two assessors. A first preselection based on the article titles was produced, regarding their availability in English or French and a second preselection was produced after reading the abstracts. In case of doubt, a third assessor’s advice was asked. Case reports were selected only if the sport involved was documented, as well as the level of practice. Cohorts were included if data about the number and the sport level of athletes were detailed. Seventy-eight articles were selected including 40 case reports, 10 clinical studies and 28 reviews of literature. Baseball pitchers seem to be highly at risk of developing a TOS. The surgical management appears particularly frequent in this specific population. The prognosis of TOS in athletes seems to be better than in the general population, possibly due to their better physical condition and their younger age. Some studies showed interesting and encouraging results concerning return to previous sport level. Literature shows a strong link between TOS and certain sports. Unfortunately, this syndrome still lacks rigorous diagnostic criteria and management guidelines for athletes.
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Affiliation(s)
- Thomas Garraud
- Hôpital Privé du Confluent, Rhumatologie, Nantes, France.,Service de Médecine du Sport, CHU Nantes, Nantes, France
| | - Germain Pomares
- Institut Européen de la Main, Luxembourg. Luxembourg.,Medical Training Center, Hopital Kirchberg, Luxembourg. Luxembourg
| | - Pauline Daley
- Service de Médecine du Sport, CHU Nantes, Nantes, France.,CHU Nantes, Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, Nantes, France
| | - Pierre Menu
- Service de Médecine du Sport, CHU Nantes, Nantes, France.,CHU Nantes, Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, Nantes, France.,Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France.,IRMS, Institut Régional de Médecine du Sport, Nantes, France
| | - Marc Dauty
- Service de Médecine du Sport, CHU Nantes, Nantes, France.,CHU Nantes, Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, Nantes, France.,Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France.,IRMS, Institut Régional de Médecine du Sport, Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine du Sport, CHU Nantes, Nantes, France.,CHU Nantes, Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, Nantes, France.,Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, Nantes, France.,IRMS, Institut Régional de Médecine du Sport, Nantes, France
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Shi Y, Zhu M, Cheng J, Zhang J, Ni Z. Venous stenosis in chronic dialysis patients with a well-functioning arteriovenous fistula. Vascular 2015; 24:25-30. [PMID: 25725216 DOI: 10.1177/1708538115575649] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose It is not clear whether patient who is dialyzing with a well-functioning vascular access may appear venous stenosis. The aim is to see the prevalence of central or other vein stenoses/occlusions in patients with asymptomatic, normal functioning fistulas. Methods A total of 54 patients met the inclusion criteria. We performed angiography examinations for these patients and reviewed venography of the superficial and deep venous systems. Results Among these patients, 21 (39%) were detected positive cases by the angiography, the remainder was negative cases. Thirteen of 54 (24%) had mild central venous stenosis (stenosis <50% diameter with or without collateral branch), 7/54 (13%) had upper arm vein system occlusion or stenosis, another one had anastomotic stenosis. There were no differences in fistula flow dynamics between those with venous abnormalities and those without such as blood flow rate, venous pressures, brachial arterial velocity, and brachial arterial flow rate. We also observed no significant differences in other variables between these two groups (including BMI, hemoglobin, albumin, gender, primary disease, URR, spKt/V P > 0.05). Conclusion The frequency of venous lesion is not low in hemodialysis patients with a well-functioning AVF. To value the impact of these abnormalities on access, prognosis needs longer time follow-up.
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Affiliation(s)
- Yaxue Shi
- Vascular Surgery Department, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Mingli Zhu
- Renal Department, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiejun Cheng
- Radiology Department, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiwei Zhang
- Vascular Surgery Department, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhaohui Ni
- Renal Department, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Kotoda A, Akimoto T, Sugase T, Yamamoto H, Kusano E. Is there a link between the structural impact of thoracic outlet and the development of central venous stenosis? Med Hypotheses 2012; 80:29-31. [PMID: 23098374 DOI: 10.1016/j.mehy.2012.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 09/24/2012] [Indexed: 10/27/2022]
Abstract
Central venous stenosis (CVS) is a serious complication for chronic hemodialysis (HD) patients. Previous reports of CVS have focused on prior central venous catheterization, because of the higher prevalence and potential for prevention of such an event. However, recent studies have demonstrated that CVS may also develop without a history of central venous catheterization. Although information about the etiological backgrounds regarding the development of CVS without previous central venous catheterization have gradually accumulated, the clinical impact of the chronic compression of the central venous system by the surrounding structures, which may likely determine the central venous susceptibility to CVS, remains poorly understood. This study proposes the hypothesis that the combination of chronic venous compression at the level of thoracic outlet characterized by the natural physique and elevated venous flow induced by the creation of vascular access should be evaluated as a potential factor for the development of CVS, since they may accelerate the development of venous stenosis, presumably through the stimulation of intimal hyperplasia, and thereby the subclavian venous susceptibility to CVS should be determined.
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Affiliation(s)
- Atsushi Kotoda
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-Shi, Tochigi 329-0498, Japan
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Revascularization of an occluded brachiocephalic vein using Outback-LTD re-entry catheter. J Vasc Surg 2010; 52:1038-40. [PMID: 20598479 DOI: 10.1016/j.jvs.2010.04.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Revised: 04/19/2010] [Accepted: 04/20/2010] [Indexed: 02/07/2023]
Abstract
A 78-year-old man with end-stage renal disease and a right brachial-cephalic upper arm direct hemodialysis access presented with symptomatic central venous occlusion. The right brachiocephalic vein occlusion in this patient was refractory to wire traversal. Sharp recanalization of the central venous occlusion was done with an Outback LTD re-entry catheter (Cordis Corporation, a Johnson & Johnson Company, Miami, Fla). The track was balloon dilated and stented. When the conventional management options fail, this technique may be used to salvage a precious dialysis access and to relieve the patient from symptoms of central venous hypertension.
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Mickley V. Central vein obstruction in vascular access. Eur J Vasc Endovasc Surg 2006; 32:439-44. [PMID: 16765068 DOI: 10.1016/j.ejvs.2006.04.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 04/26/2006] [Indexed: 10/24/2022]
Abstract
Central venous obstruction has become a major problem because of the frequent need for central venous catheters in haemodialysis patients. This article discusses the epidemiology and clinical features of central venous obstruction and the different surgical and interventional alternatives for its treatment.
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Affiliation(s)
- V Mickley
- Department of Vascular Surgery, Kreiskrankenhaus Rastatt, Engelstrasse 39, D-76437, Germany.
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