Samuel S. Ahn2, Travis J. Miller3, Julia F. Chen3, Sheena W. Chen3, Robert Feldtman1, William Hwang4
1DFW Vascular Group, Dallas, TX; 2University Vascular Associates, Los Angeles, CA; 3UTSW Medical School, Dallas, TX; 4Neurologist, Dallas, TX.
OBJECTIVES: Traditionally, thoracic outlet syndrome (TOS) has been associated with axillo-subclavian vein stenosis without any mention of the internal jugular (IJ) vein. However, we recently reported a high prevalence of IJ stenosis in 109 patients with TOS in a limited study. To confirm this finding, we analyzed a bigger cohort of patients.
METHODS: We retrospectively analyzed 237 consecutive unique patients referred to our practice with thoracic outlet syndrome. From April 2008 to Dec 2012, all patients underwent diagnostic brachiocephalic venograms. Average age was 49.9 years (r:17 to 81), with 71.8% females and 28.2% male. We looked at the right and left internal jugular veins and the right and left subclavian veins. Stenoses were classified into high (>66%), medium (33%-66%) and low (<33%). We also looked for presence of collaterals around the obstructions. Venogram findings were confirmed by four investigators independently. For the purposes of this analysis, high stenosis was considered significant. Medium and low stenoses were considered significant only if there were visible collaterals.
RESULTS: Left internal jugular vein stenosis, left subclavian vein stenosis, right internal jugular vein stenosis, and right subclavian vein stenosis was seen in 67.5%, 57.6%, 62.7% and 61.6% of patients, respectively. Internal jugular vein stenosis was not present in 18.1% of patients, present unilaterally in 33.3% of patients and present bilaterally in 48.5% of patients. Subclavian vein stenosis was not present in 24.1% of patients, present unilaterally in 32.5% of patients and present bilaterally in 43.5% of patients. Significant collaterals were present in 26.80% of high stenosis, 21.5% of medium and 12.8% of low.
CONCLUSIONS: Internal jugular vein stenosis is common in patients with thoracic outlet symptoms. Treatment of internal jugular vein stenosis potentially could benefit these patients. These findings could fundamentally change the diagnosis and treatment of thoracic outlet syndrome. Further studies are warranted.
AUTHOR DISCLOSURES: S. S. Ahn: Nothing to disclose; J. F. Chen: Nothing to disclose; S. W. Chen: Nothing to disclose; R. Feldtman: Nothing to disclose; W. Hwang: Nothing to disclose; T. J. Miller: Nothing to disclose.
Posted April 2013