VTOS in the pediatric age group

VTOS in the pediatric patient is usually due to either positional obstruction or effort thrombosis. Children may present with acute symptoms of arm swelling and discomfort and some may present with chronic symptoms associated with dilated collateral veins. All patients should undergo hypercoagulable workup and duplex imaging of the axillo-subclavian vein to confirm the diagnosis. Further imaging of the thoracic outlet for soft tissue or osseous abnormalities should be also be performed. Those patients with acute thrombosis can undergo thrombolysis, followed by surgical decompression and anticoagulation. Patients who present with chronic symptoms should undergo decompressive surgery and adjunctive venolysis or repair followed by anticoagulation. Prognosis following decompression is superior to anticoagulation alone. Available evidence suggests a higher rate of bony abnormalities in this group, and that treatment should be identical to that of this condition in adults.