THE USE OF INTRAVASCULAR ULTRASOUND IN THE MANAGEMENT OF THORACIC OUTLET SYNDROME

We have reviewed our early experience with intravascular ultrasound in the management of thoracic outlet syndrome. Eight patients presenting with symptoms of venous obstruction secondary to thoracic outlet synd rome have been evaluated by duplex ultrasound, contrast venography, an d intravascular ultrasound (IVUS). IVUS was performed at the same time as venography, using the brachial venous access site. In all eight pa tients IVUS and venography were in agreement. IVUS was able to identif y the etiology of the stenoses. Four of the six patients with abnormal IVUS studies have had surgery, and IVUS was used intraoperatively dur ing three of these cases. Based on the demonstration of release of ext rinsic compression by real time imaging, it was possible to limit the necessary dissection to two first rib resections alone and one resecti on of just the insertion of the pectoralis minor muscle. Three of the four patients have had complete resolution of their symptoms postopera tively. Currently, the average follow-up time is 13 months. One patien t who was a recurrent procedure has had a minor relapse at 6 months. T here have been no complications. These results have shown that IVUS is a safe technique and is as accurate as venography in identifying the sites and degree of narrowing. IVUS provides additional data as well r egarding the etiology of the underlying process. The intraoperative us e of IVUS has proved helpful in decision-making to minimize the dissec tion necessary to release extrinsic venous compression. The operative results compare favorably with those found in the literature.