JVS Publishes First-Ever TOS Reporting Standards

CHICAGO, Illinois, Aug. 23, 2016 - New thoracic outlet syndrome (TOS) reporting standards have been published by the Society for Vascular Surgery (SVS) in the September 2016 issue of Journal of Vascular Surgery.

Because the syndrome can be caused by repeated movements that cause extreme stress to the upper extremities, it has affected athletes such as New York Mets pitcher Matt Harvey and Tampa Bay Lightning hockey players Andrei Vasilevskiy and Steven Stamkos.

Thoracic outlet syndrome refers to a group of potentially disabling conditions thought to be caused by compression of neurovascular structures serving the upper extremity.

“A major portion of the reporting standards document is designed to standardize diagnosis of TOS,” said vascular surgeon Dr. Karl Illig, who recently treated the two Lightning players. “There’s no objective test. No one can agree what it is.”

Without these reporting standards, research is challenging to plan and perform, and published literature is frequently difficult to interpret and compare, states the reporting standards document. That’s a situation that leads to highly variable care.

The standards, which were three years in development by a vascular surgeons’ committee appointed by the SVS, are designed to:

• Standardize terminology and consensus on the diagnosis, degrees of severity and methods of measuring outcomes;

• Establish consistent reporting standards for all three forms of TOS - neurogenic (NTOS), venous (VTOS) and arterial (ATOS).

The knowledge base for the syndrome, particularly the neurogenic form, is inadequate, said Dr. Illig, co-chair of the committee with Dr. Audra Duncan. To aid in making a diagnosis, the standards document lists four criteria for NTOS, which is the most difficult to diagnose.

The presence of three out of four 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

“We all need to be describing the same thing,” Dr. Illig said. “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 five to 10 years. Eventually a treatment guideline will allow treatment to be guided by empirical, reproducible data, Dr. Illig said.

Read the complete guidelines here