Association between subclavian vein patency and health-related quality of life outcomes among patients with venous thoracic outlet syndrome.

Abstract

The study objective was to evaluate the association between subclavian vein patency and health-related quality of life after supraclavicular thoracic outlet decompression among patients with venous thoracic outlet syndrome. Patients who underwent supraclavicular thoracic outlet decompression (ie, first thoracic rib resection, scalenectomy, and subclavian venolysis) were identified from a prospectively maintained database. Demography, perioperative venography, and catheter-directed interventions were recorded. The primary end points were subclavian vein patency and health-related quality of life after decompression. The association between subclavian vein patency and health-related quality of life was evaluated in unadjusted and logistic regression analyses. Among 1032 patients with thoracic outlet syndrome who underwent surgery (2007-2021), 275 patients presented with venous thoracic outlet syndrome. A total of 225 patients (81.8%) underwent preoperative venography; 221 patients (98.2%) had completely or partially stenosed subclavian veins. Preoperative catheter-based interventions were performed in 166 patients (60.4%); stenosis remained in 130 patients (78.3%). Postoperatively, 216 patients (78.5%) underwent routine venography; improvement in stenosis was observed in 54 patients (25.0%). Additional catheter-based interventions were performed in 155 patients (56.4%) with improvement in stenosis observed in 131 patients (84.5%). At a median follow-up of 279 days (interquartile range, 95-674), 94.0% of patients reported improvement in health-related quality of life. Improvement in subclavian vein patency was associated with improved health-related quality of life (adjusted odds ratio, 2.19 [95% CI, 1.12-4.28], P = .021). Subclavian vein patency is associated with improved health-related quality of life among patients with venous thoracic outlet syndrome. Effective venolysis during thoracic outlet decompression with perioperative catheter-directed intervention contributes most significantly to vein patency.