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Evaluation and treatment of thoracic outlet syndrome during the global pandemic due to SARS-CoV-2 and COVID-19.

Authors
  • Ohman, J Westley1
  • Annest, Stephen J2
  • Azizzadeh, Ali3
  • Burt, Bryan M4
  • Caputo, Francis J5
  • Chan, Colin6
  • Donahue, Dean M7
  • Freischlag, Julie A8
  • Gelabert, Hugh A9
  • Humphries, Misty D10
  • Illig, Karl A11
  • Lee, Jason T12
  • Lum, Ying Wei13
  • Meyer, Richard D14
  • Pearl, Gregory J15
  • Ransom, Erin F14
  • Sanders, Richard J16
  • Teijink, Joep A W17
  • Vaccaro, Patrick S18
  • van Sambeek, Marc R H M19
  • And 2 more
  • 1 Center for Thoracic Outlet Syndrome and Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo.
  • 2 Vascular Surgery, Presbyterian/St. Luke's Hospital and St. Joseph Hospital, Denver, Colo.
  • 3 Division of Vascular Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif.
  • 4 Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
  • 5 Department of Vascular Surgery, Sydell and Arnold Miller Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
  • 6 Department of Vascular Surgery, Wirral University Teaching Hospital and Countess of Chester Hospital NHS Foundation Trust, Chester, United Kingdom. , (United Kingdom)
  • 7 Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
  • 8 Wake Forest Baptist Medical Center, Wake Forest School of Medicine, Winston-Salem, NC.
  • 9 Division of Vascular Surgery, Gonda (Goldschmied) Vascular Center, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
  • 10 Division of Vascular Surgery, University of California, Davis Medical Center, Sacramento, Calif.
  • 11 Dialysis Access Institute, Regional Medical Center, Orangeburg, SC.
  • 12 Division of Vascular Surgery, Department of Surgery, Stanford Hospital and Clinics, Stanford, Calif.
  • 13 Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Md.
  • 14 Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, Ala.
  • 15 Division of Vascular Surgery, Baylor University Medical Center, and Baylor Scott & White Heart and Vascular Hospital, Dallas, Tex.
  • 16 Department of Surgery, University of Colorado Health Science Center, Aurora, Colo.
  • 17 Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. , (Netherlands)
  • 18 Division of Vascular Diseases and Surgery, The Ohio State University College of Medicine, Columbus, Ohio.
  • 19 Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Biomedical Technology, University of Technology Eindhoven, Eindhoven. , (Netherlands)
  • 20 Section of Vascular Surgery, Department of Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Mich.
  • 21 Center for Thoracic Outlet Syndrome and Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo. Electronic address: [email protected]
Type
Published Article
Journal
Journal of vascular surgery
Publication Date
Sep 01, 2020
Volume
72
Issue
3
Pages
790–798
Identifiers
DOI: 10.1016/j.jvs.2020.05.048
PMID: 32497747
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The global SARS-CoV-2/COVID-19 pandemic has required a reduction in nonemergency treatment for a variety of disorders. This report summarizes conclusions of an international multidisciplinary consensus group assembled to address evaluation and treatment of patients with thoracic outlet syndrome (TOS), a group of conditions characterized by extrinsic compression of the neurovascular structures serving the upper extremity. The following recommendations were developed in relation to the three defined types of TOS (neurogenic, venous, and arterial) and three phases of pandemic response (preparatory, urgent with limited resources, and emergency with complete diversion of resources). • In-person evaluation and treatment for neurogenic TOS (interventional or surgical) are generally postponed during all pandemic phases, with telephone/telemedicine visits and at-home physical therapy exercises recommended when feasible. • Venous TOS presenting with acute upper extremity deep venous thrombosis (Paget-Schroetter syndrome) is managed primarily with anticoagulation, with percutaneous interventions for venous TOS (thrombolysis) considered in early phases (I and II) and surgical treatment delayed until pandemic conditions resolve. Catheter-based interventions may also be considered for selected patients with central subclavian vein obstruction and threatened hemodialysis access in all pandemic phases, with definitive surgical treatment postponed. • Evaluation and surgical treatment for arterial TOS should be reserved for limb-threatening situations, such as acute upper extremity ischemia or acute digital embolization, in all phases of pandemic response. In late pandemic phases, surgery should be restricted to thrombolysis or brachial artery thromboembolectomy, with more definitive treatment delayed until pandemic conditions resolve. Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

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