Abstract
Introduction and objectives
The role of preoperative thrombectomy/thrombolysis and the optimal timing of angioplasty relative to first rib resection (FRR) for venous thoracic outlet syndrome (vTOS) remain uncertain. We evaluated reintervention rates after FRR with and without preoperative thrombectomy/thrombolysis, and with same-day versus delayed angioplasty.Methods
Patients who underwent FRR and angioplasty between 2015-2025 were identified in a national database. Cohorts were defined as FRR with or without preoperative thrombectomy/thrombolysis, and FRR with same-day or delayed angioplasty within 8 weeks of the index operation. Propensity score matching was performed on race, age, sex, and comorbidities. The primary outcome was re-angioplasty rates at 1, 3, and 5 years. Outcomes were compared using Kaplan-Meier analysis and log-rank testing.Results
Of 635 patients undergoing FRR and angioplasty, 163 (26.1%) received preoperative thrombectomy/thrombolysis and 383 (61.3%) underwent delayed angioplasty. After matching, 154 patients were included in each thrombectomy/thrombolysis cohort and 240 in each angioplasty-timing cohort. Re-angioplasty rates did not differ significantly by preoperative thrombectomy/thrombolysis at 1-year (8.4% vs 9.7%, p=0.64), 3-years (10.4% vs 10.4%, p=0.84), or 5-years (10.4% vs 12.3%, p=0.86). Re-angioplasty rates were also similar between delayed and same-day angioplasty cohorts at 1-year (9.6% vs 12.9%, p=0.27), 3-years (10.4% vs 15.8%, p=0.11), and 5-years (10.4% vs 17.1%, p=0.06).Conclusions
In this national matched cohort, preoperative thrombectomy/thrombolysis was not associated with lower re-angioplasty rates after FRR for vTOS. Angioplasty timing was likewise not significantly associated with reintervention, although delayed angioplasty showed a non-significantly lower 5-year re-angioplasty rate.