Controversies in VTOS: Is There Ever a Role for Venous Stents in VTOS?



The bony venous thoracic outlet creates significant extrinsic force upon the subclavian vein, and intravascular stents in this location thus perform very poorly. There is some literature supporting the use of stents after decompression, but no level I evidence exists. At present the use of stents in venous thoracic outlet syndrome should not be considered until the bony thoracic outlet has been decompressed, and even then should be reserved for isolated cases with thorough followup.


Stent Placement Subclavian Vein Surgical Decompression Thoracic Outlet Syndrome Venous Outflow Obstruction 
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  1. 1.
    Gutzeit A, Zollikofer CL, Dettling-Pizzolato M, Graf N, Largiadèr J, Binkert CA. Endovascular stent treatment for symptomatic benign iliofemoral venous occlusive disease: long-term results 1987–2009. Cardiovasc Intervent Radiol. 2011;34:542–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Rosales A, Sandbaek G, Jørgensen JJ. Stenting for chronic post-thrombotic vena cava and iliofemoral venous occlusions: mid-term patency and clinical outcome. Eur J Vasc Endovasc Surg. 2010;40(2):234–40.PubMedCrossRefGoogle Scholar
  3. 3.
    Illig KA, Doyle A. A comprehensive review of Paget-Schroetter syndrome. J Vasc Surg. 2010;51:1538–47.PubMedCrossRefGoogle Scholar
  4. 4.
    Urschel Jr HC, Patel AN. Paget Schroetter syndrome therapy: failure of intravenous stents. Ann Thorac Surg. 2003;75:1693–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Canales JF, Krajcer Z. Intravascular ultrasound guidance in treating May-Thurner syndrome. Tex Heart Inst J. 2010;37(4):496–7.PubMedGoogle Scholar
  6. 6.
    Forauer AR, Gemmete JJ, Dasika NL, Cho KJ, Williams DM. Intravascular ultrasound in the diagnosis and ­treatment of iliac vein compression (May-Thurner) syndrome. J Vasc Interv Radiol. 2002;13(5):523–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Neglén P, Raju S. Intravascular ultrasound scan evaluation of the obstructed vein. J Vasc Surg. 2002;35(4):694–700.PubMedCrossRefGoogle Scholar
  8. 8.
    Glass C, Gillespie D. Intravascular ultrasound for innominate vein and superior vena cava stenting. San Diego: American Venous Forum; 2011.Google Scholar
  9. 9.
    Freischlag J. Venous thoracic outlet syndrome: transaxillary approach. Oper Tech Gen Surg. 2008;10:122–30.CrossRefGoogle Scholar
  10. 10.
    Schneider DB, Dimuzio PJ, Martin ND, Gordon RL, Wilson MW, Laberge JM, Kerlan RK, Eichler CM, Messina LM. Combination treatment of venous thoracic outlet syndrome: open surgical decompression and intraoperative angioplasty. J Vasc Surg. 2004;40(4):599–603.PubMedCrossRefGoogle Scholar
  11. 11.
    Stone DH, Scali ST, Bjerk AA, Rzucidlo E, Chang CK, Goodney PP, Nolan BW, Walsh DB. Aggressive ­treatment of idiopathic axillo-subclavian vein thrombosis provides excellent long-term function. J Vasc Surg. 2010;52(1):127–31. Epub 2010 Apr 10.PubMedCrossRefGoogle Scholar
  12. 12.
    Doyle A, Wolford HY, Davies MG, Adams JT, Singh MJ, Saad WE, Waldman DL, Deweese JA, Illig KA. Management of effort thrombosis of the subclavian vein: today’s treatment. Ann Vasc Surg. 2007;21(6):723–9. Epub 2007 Oct 17.PubMedCrossRefGoogle Scholar
  13. 13.
    Guzzo JL, Chang K, Demos J, Black JH, Freischlag JA.Preoperative thrombolysis and venoplasty affords no benefit in patency following first rib resection and ­scalenectomy for subacute and chronic subclavian vein thrombosis. J Vasc Surg. 2010;52(3):658–62; ­discussion 662–3.PubMedCrossRefGoogle Scholar
  14. 14.
    Kreienberg PB, Chang BB, Darling 3rd RC, Roddy SP, Paty PS, Lloyd WE, Cohen D, Stainken B, Shah DM. Long-term results in patients treated with thrombolysis, thoracic inlet decompression, and subclavian vein stenting for Paget-Schroetter syndrome. J Vasc Surg. 2001;33(2 Suppl):S100–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Molina JE. A new surgical approach to the innominate and subclavian vein. J Vasc Surg. 1998;27(3):576–81.PubMedCrossRefGoogle Scholar
  16. 16.
    Pupka A, Szyber PP, Garcarek J, Szyber P. The use of intravascular nitinol stents in the treatment of subclavian vein compression for thoracic outlet syndrome. Polim Med. 2007;37(2):51–5.PubMedGoogle Scholar
  17. 17.
    Illig K. Management of central vein stenoses and occlusions: the critical importance of the costoclavicular junction. Semin Vasc Surg. 2011;24(2):113–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Glass C, Dugan M, Gillespie D, Doyle A, Illig K. Costoclavicular venous decompression in patients with threatened arteriovenous hemodialysis access. Ann Vasc Surg. 2011;25(5):640–5. Epub ahead of print.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Department of Vascular SurgeryStrong Memorial HospitalRochesterUSA
  2. 2.Department of SurgeryUniversity of Rochester Medical CenterRochesterUSA

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