Work

Post-thrombotic syndrome after thrombotic venous thoracic outlet syndrome

Year: 2026

Type: article

Abstract: BACKGROUND: Thrombotic venous thoracic outlet syndrome (T-vTOS), including Paget-Schrotter syndrome, is a rare form of upper extremity deep vein thrombosis that mainly affects young, active individuals. Its optimal management remains debated, and the medium-term outcomes have been poorly documented. METHODS: This retrospective study included consecutive patients diagnosed with T-vTOS at the vascular medicine department of a university hospital between 2014 and 2024. Patients were stratified according to the presence of post-thrombotic syndrome (PTS) using the modified Villalta score at the last follow-up (<5 vs ≥5). Clinical characteristics, therapeutic strategies, and outcomes were systematically assessed through a standardized evaluation performed by the same physician. Univariable and multivariable logistic regression analyses, using Firth's penalized-likelihood method to account for the limited number of events, were performed to identify the factors associated with PTS. RESULTS: A total of 50 patients were included: 28 with a Villalta score of <5 and 22 with a Villalta score of ≥5 at the last follow-up. Patients with a Villalta score of <5 achieved higher rates of complete subclavian vein recanalization at follow-up (63% vs 32%; P = .045) and were less likely to have persistent subclavian vein occlusion (26% vs 59%; P = .023). Patients with a Villalta score of ≥5 more often required prolonged anticoagulation (73% vs 29%; P = .004) and more frequently underwent acute-phase endovascular treatment (36% vs 4%; P = .007). In the multivariable analysis, endovascular treatment alone without thoracic outlet surgery was associated with an increased risk of PTS (odds ratio, 10.6; 95% confidence interval, 1.15, 98.09) (P = .037), whereas no association was found between the risk of PTS and patients who had undergone both endovascular treatment and TOS surgery (odds ratio 1.3; 95% confidence interval, 0.26, 6.87) (P = .736). CONCLUSIONS: This study highlights the central role of venous patency in the clinical course of T-vTOS, with persistent subclavian vein occlusion associated with an increased risk of PTS. The association observed between acute-phase endovascular treatment alone and the risk of PTS does not support a clear benefit of this strategy. However, endovascular therapy in conjunction with surgical decompression of the thoracic outlet may reduce the risk of PTS.

Source: Journal of Vascular Surgery Venous and Lymphatic Disorders

DOI: 10.1016/j.jvsv.2026.102639