Diseases of the aorta, pulmonary and peripheral vessels: Edited by Alan BravermanContemporary management of thoracic outlet syndromeBrooke, Benjamin S; Freischlag, Julie AAuthor Information Department of Surgery, Division of Vascular and Endovascular Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA Correspondence to Julie A. Freischlag, MD, Johns Hopkins Hospital, 720 Rutland Avenue, Ross 759, Baltimore, MD 21205, USA Tel: +1 443 287 3498; fax: +1 443 287 3500; e-mail: [email protected] Current Opinion in Cardiology: November 2010 - Volume 25 - Issue 6 - p 535-540 doi: 10.1097/HCO.0b013e32833f028e Buy Metrics Abstract Purpose of review The diagnosis and management of thoracic outlet syndrome (TOS) has been surrounded by controversy since this disorder was first recognized. Recent evidence from observational studies has helped us better understand the pathophysiology of different TOS subtypes and guide clinical decision making for this disorder. Recent findings The identification of anatomic anomalies involved with the cause of different TOS subtypes has been made easier by contemporary diagnostic techniques. This includes the injection of neuromuscular blocking agents into anterior scalene muscles to help confirm the diagnosis of neurogenic TOS. Surgical intervention by means of first rib resection and anterior scalenectomy is an effective treatment for patients diagnosed with neurogenic and venous TOS, resulting in a significant increase in quality-of-life measures for the majority of patients. Patients with acute and chronic venous TOS should be maintained on anticoagulation during the perioperative period and may not need thrombolysis prior to surgery. Finally, patients with arterial TOS should undergo cervical or first rib resection with or without arterial reconstruction to alleviate and prevent recurrence of symptoms. Summary The management of TOS requires a multidisciplinary approach with specific treatment algorithms for each TOS subtype. Appropriately selected patients with all different types of TOS may benefit from surgical intervention. © 2010 Lippincott Williams & Wilkins, Inc.