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2020 ; 72
(3
): 790-798
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Evaluation and treatment of thoracic outlet syndrome during the global pandemic
due to SARS-CoV-2 and COVID-19
#MMPMID32497747
Ohman JW
; Annest SJ
; Azizzadeh A
; Burt BM
; Caputo FJ
; Chan C
; Donahue DM
; Freischlag JA
; Gelabert HA
; Humphries MD
; Illig KA
; Lee JT
; Lum YW
; Meyer RD
; Pearl GJ
; Ransom EF
; Sanders RJ
; Teijink JAW
; Vaccaro PS
; van Sambeek MRHM
; Vemuri C
; Thompson RW
J Vasc Surg
2020[Sep]; 72
(3
): 790-798
PMID32497747
show ga
The global SARS-CoV-2/COVID-19 pandemic has required a reduction in nonemergency
treatment for a variety of disorders. This report summarizes conclusions of an
international multidisciplinary consensus group assembled to address evaluation
and treatment of patients with thoracic outlet syndrome (TOS), a group of
conditions characterized by extrinsic compression of the neurovascular structures
serving the upper extremity. The following recommendations were developed in
relation to the three defined types of TOS (neurogenic, venous, and arterial) and
three phases of pandemic response (preparatory, urgent with limited resources,
and emergency with complete diversion of resources). ? In-person evaluation and
treatment for neurogenic TOS (interventional or surgical) are generally postponed
during all pandemic phases, with telephone/telemedicine visits and at-home
physical therapy exercises recommended when feasible. ? Venous TOS presenting
with acute upper extremity deep venous thrombosis (Paget-Schroetter syndrome) is
managed primarily with anticoagulation, with percutaneous interventions for
venous TOS (thrombolysis) considered in early phases (I and II) and surgical
treatment delayed until pandemic conditions resolve. Catheter-based interventions
may also be considered for selected patients with central subclavian vein
obstruction and threatened hemodialysis access in all pandemic phases, with
definitive surgical treatment postponed. ? Evaluation and surgical treatment for
arterial TOS should be reserved for limb-threatening situations, such as acute
upper extremity ischemia or acute digital embolization, in all phases of pandemic
response. In late pandemic phases, surgery should be restricted to thrombolysis
or brachial artery thromboembolectomy, with more definitive treatment delayed
until pandemic conditions resolve.