SVS Announces New Reporting Standards for Thoracic Outlet Syndrome

August 23, 2016—The Society for Vascular Surgery (SVS) announced the publication of new reporting standards for thoracic outlet syndrome (TOS) by Karl A. Illig, MD, et al in the Journal of Vascular Surgery (2016;64:797–802). A committee of vascular surgeons appointed by SVS and chaired by Dr. Illig and Audra Duncan, MD, produced the standards, which were developed over 3 years. 

SVS noted that TOS refers to a group of potentially disabling conditions thought to be caused by compression of neurovascular structures that serve the upper extremity. Because the syndrome can be caused by repeated movements that result in extreme stress to the upper extremities, it has affected prominent athletes, such as professional ice hockey players. 

In the SVS announcement, Dr. Illig stated, “A major portion of the reporting standards document is designed to standardize diagnosis of TOS. There’s no objective test. No one can agree what it is.”

The reporting standards document states that research is challenging to plan and perform, and published literature can be difficult to interpret and compare, which leads to highly variable care.

According to SVS, the document standardizes terminology and consensus on the diagnosis, degrees of severity, and methods of measuring outcomes for TOS and establishes consistent reporting standards for all three forms of TOS—neurogenic, venous, and arterial. 

Dr. Illig advised that the knowledge base for the syndrome, particularly the neurogenic form, is inadequate. To aid in making a diagnosis, the standards document lists four criteria for neurogenic TOS, which is the most difficult to diagnose. The presence of three of these four factors indicates the syndrome:

•  Local symptoms, with pain and tenderness at the scalene triangle
•  Evidence of nerve compression, such as numbness and tingling in the hand and arm
•  Absence of other likely diagnoses
•  A positive scalene muscle test block

Dr. Illig commented, “We all need to be describing the same thing. We have to all agree on the definition of TOS and agree on what constitutes good, bad, and medium outcomes. This paper is a call to the profession to begin this important work.”

Committee members hope that if surgeons agree to participate in unified data collection, practice guidelines can follow in 5 to 10 years. Eventually a treatment guideline will allow treatment to be guided by empirical, reproducible data, concluded Dr. Illig in the SVS announcement.