THE THORACIC OUTLET SYNDROME (TOS) AND ITS APPARENT RELATION TO MULTIPLE SCLEROSIShttp://cirugiavascularactual.blogspot.c ... d-its.html
Summary and conclusions.
This is an update of our current knowledge and experience in the surgical treatment of TOS. The clinical aspects, pathology and complications of this disease are widely ignored and at times denied. Clinically it affects the upper limbs presenting with pain, ischemic phenomena, and venous congestion, all this may appear isolated or combined which may lead to diagnostic confusion, this is due to neurovascular bundle compression at the thoracic outlet triangles and the first rib upper edge.
Usually this situation is bilateral, but always more evident on one side, TOS may also present with more atypical symptoms as headaches, minor visual disturbances tinnitus of unexplained origin, or chest, neck and shoulder pain.
A detailed description of the vascular laboratory facilities is given, noteworthy are the different plethysmographyc evaluations and Echo Doppler that make evident jugular vein retrograde reflux.
Of the different surgical approaches to treat TOS, the transaxillary route of Roos has been our choice for many years, for it is safer. A transverse skin incision on the skin of the thoracic of the lower axilla opens the route to further upwards dissection that shall finally lead to the anterior arch of the first rib which, after careful dissection is partially extirpated liberating the pressure on the neurovascular structures.
Dr. Paolo Zamboni´s research and clinical experiences led us to determine the existence of jugular vein reflux in almost all TOS patients complicated with MS patients, and logically presuming proximal venous stenosis.
He treated these patients only with venous angioplasties, obtaining favorable results in some patients confirming his theory of venous hypertension as an important factor in the genesis of MS. The importance of his research and clinical experience have set a milestone in the research and treatment of TOS and MS and for the continuing scientific and clinical research in this apparently confusing subject of chronic cerebral venous hypertension.