Clinical presentation and patient evaluation in VTOS

Abstract

This chapter traces the historical development of our current understanding of the pathophysiology of TOS and discusses the specific anatomic relationships at the thoracic outlet pertinent to venous TOS (VTOS). The clinical presentation of patients with VTOS is described, and the diagnostic evaluation is outlined. A unified, multi-modal approach to Paget-von Schroetter syndrome is discussed, which includes catheter-directed lytic therapy, surgical thoracic outlet decompression, endovenous intervention for intrinsic venous disease, and systemic anticoagulation. Several possible clinical scenarios are discussed and treatment algorithms presented.