Hydrodissection for the Treatment of Vascular Thoracic Outlet Syndrome

Abstract

The following case explores the effectiveness of a new treatment modality for vascular thoracic outlet syndrome (vTOS). Few conservative treatments exist to alleviate symptoms of vTOS. In this case, a 25-year-old male was diagnosed with vTOS four months prior to presentation. A combination of poor posture, inactivity, and protruding screws from a prior clavicle fracture repair were compromising the subclavicular vasculature. Symptoms of claudication and a cold right arm/hand led the patient to seek medical treatment. Post failed physiotherapy and pharmacotherapy, the vascular surgeon advised for surgery. He was hesitant to undergo major surgical intervention; therefore, after exploring possible remedies, hydrodissection was chosen for its potential merit in this case. After hydrodissection was performed to decompress the subclavicular neurovascular bundle, the patient reported immediate alleviation of his symptoms. Post two-week and three-month follow-up, there was complete resolution of symptoms with no recurrence. Although there is a lack of literature supporting the use of hydrodissection to treat vTOS, this was a specific case in which hydrodissection demonstrated to be an effective treatment modality. The specific utilization of hydrodissection should be further studied to increase the literature base and increase awareness of its potential effectiveness for this and similar conditions.