In the postprocedure setting, catheter arteriography may be performed to evaluate and intervene on suspected or confirmed arterial complications. Catheter Venography Upper Extremity Diagnostic venography may be performed for suspected vTOS in which the veins of the affected extremity are catheterized, and contrast injection is performed via the catheter during digital subtraction acquisition in both neutral and stressed positions. Typical findings include narrowing of the subclavian vein with appearance of venous collateral vessels. These are generally seen projecting over the thorax or across the neck. Total occlusion of the subclavian vein may be present in chronic or acute TOS, and all findings may be present on only stressed position venography or at stress and neutral positions. Thoracic Outlet Syndrome As part of the evaluation for surgical decompression, patients may also undergo contralateral venography as well as catheter-directed thrombolysis. Angioplasty is not typically performed in the chronic setting, and at some centers, it is generally avoided prior to surgical decompression. In patients with total or near-total subclavian vein occlusion, endovascular recanalization of the subclavian vein may be attempted, and, if successful, a peripherally inserted central venous catheter is occasionally inserted and positioned so that it courses across the newly recanalized venous segment. It is then left indwelling until after surgical decompression is performed so as to preserve a route of intraluminal access across the diseased subclavian vein segment. One advantage of venography as a diagnostic tool is that other presurgery interventions may be performed, including intravascular thrombolysis, thrombectomy, and angioplasty. For postsurgical decompression, catheter venography is often indicated for evaluation of residual narrowing and possible US angioplasty of the diseased or stenosed segment with the external compression [31,32].
Thoracic Outlet Syndrome. In the postprocedure setting, catheter arteriography may be performed to evaluate and intervene on suspected or confirmed arterial complications. Catheter Venography Upper Extremity Diagnostic venography may be performed for suspected vTOS in which the veins of the affected extremity are catheterized, and contrast injection is performed via the catheter during digital subtraction acquisition in both neutral and stressed positions. Typical findings include narrowing of the subclavian vein with appearance of venous collateral vessels. These are generally seen projecting over the thorax or across the neck. Total occlusion of the subclavian vein may be present in chronic or acute TOS, and all findings may be present on only stressed position venography or at stress and neutral positions. Thoracic Outlet Syndrome As part of the evaluation for surgical decompression, patients may also undergo contralateral venography as well as catheter-directed thrombolysis. Angioplasty is not typically performed in the chronic setting, and at some centers, it is generally avoided prior to surgical decompression. In patients with total or near-total subclavian vein occlusion, endovascular recanalization of the subclavian vein may be attempted, and, if successful, a peripherally inserted central venous catheter is occasionally inserted and positioned so that it courses across the newly recanalized venous segment. It is then left indwelling until after surgical decompression is performed so as to preserve a route of intraluminal access across the diseased subclavian vein segment. One advantage of venography as a diagnostic tool is that other presurgery interventions may be performed, including intravascular thrombolysis, thrombectomy, and angioplasty. For postsurgical decompression, catheter venography is often indicated for evaluation of residual narrowing and possible US angioplasty of the diseased or stenosed segment with the external compression [31,32].