Current trends in the treatment of venous thoracic outlet syndrome: a comprehensive review

Venous thoracic outlet syndrome (TOS) is a less common presentation than neurogenic TOS. It is caused by venous obstruction due to axillosubclavian venous thrombosis or, less frequently, nonthrombotic external compression. Thrombotic venous TOS is commonly known as Paget–Schroetter syndrome and primarily involves axillosubclavian vein thrombosis. Patients with nonthrombotic forms of venous TOS typically have normal venography at rest, but arm abduction generates a positional venous compression resulting in arm swelling and pain. This paper reviews the anatomy and pathophysiology associated with venous TOS and suggests an approach for diagnostic workup and treatment. Controversies exist as to the most appropriate treatment and, in particular, the timing of treatment during the natural course of the disease. Here we describe treatment options and suggest an algorithm for appropriate, safe and effective patient management.