Thoracic outlet syndrome: a survey of operative practice amongst vascular surgeons

Introduction: Thoracic outlet syndrome (TOS) poses a significant challenge in clinical management due to its varied presentation and impact on patients’ quality of life. Currently, there are no standardised guidelines used for the management of these patients and guide surgical intervention. This survey aimed to assess practices related to the pre-, peri-, and postoperative management of patients with TOS amongst vascular surgeons. Methods: This online cross-sectional survey was designed and distributed to vascular surgeons at consultant or specialist registrar levels. The survey was designed by two vascular surgery trainees and validated by vascular surgery consultants with a specialist interest in TOS. Data collection occurred over eight months through an online survey platform, and responses were analysed using descriptive statistics and narrative analysis. Results: The survey was completed by 81 vascular surgeons. This included 55 consultant-level and 26 speciality registrar-level surgeons, primarily from the UK. Most survey respondents (86%) reported that their centre performed surgical decompression for TOS. The median number of cases performed by each centre annually was eight. Venous and neurogenic TOS were the most reported indications for surgical intervention (78%) and the supraclavicular approach was the most frequently used operative approach (87%). There did not appear to be any standardisation in postoperative management or follow-up, including reporting of treatment outcomes. Conclusions: This survey highlights the significant variability in pre- and postoperative practices related to TOS among vascular surgeons. Further research, including observational studies, is needed to better understand the relationship of assessment, surgical approaches and perioperative care with patient outcomes to help guide future practice.