• J Westley Ohman, Stephen J Annest, Ali Azizzadeh, Bryan M Burt, Francis J Caputo, Colin Chan, Dean M Donahue, Julie A Freischlag, Hugh A Gelabert, Misty D Humphries, Karl A Illig, Jason T Lee, Ying Wei Lum, Richard D Meyer, Gregory J Pearl, Erin F Ransom, Richard J Sanders, Teijink Joep A W JAW Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Epidemiology, CAPHRI School for Public Health and Prima, Patrick S Vaccaro, van Sambeek Marc R H M MRHM Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Department of Biomedical Technology, University of Technology , Chandu Vemuri, and Robert W Thompson.
• Center for Thoracic Outlet Syndrome and Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Mo.
• J. Vasc. Surg. 2020 Sep 1; 72 (3): 790-798.

AbstractThe 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.Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

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