Hydrodissection for Treatment of Vascular Thoracic Outlet Syndrome

The following case explores the effectiveness of a new treatment modality in the case of vascular thoracic outlet syndrome (vTOS). Few conservative treatments exist for use in alleviating symptoms of vTOS. In this case, a 25 year old male was diagnosed with vTOS 4 months prior to presentation. A combination of poor posture, inactivity, and protruding screws from a previous clavicle fracture repair were compromising the subclavicular vasculature. Symptoms of claudication and a cold right arm/hand led to the patient seeking medical treatment. He had failed physical therapy and pharmacotherapy, was told by a vascular surgeon that he was a surgical candidate. He sought non-surgical options for treatment, and after exploring possible remedies, hydrodissection was chosen for its potential merit in this case. After utilizing the treatment and decompressing the subclavicular neurovascular bundle, the patient reported immediate alleviation of his symptoms. After a 2 week and 3 month follow up, the patient still reports 100% reduction in symptoms with no recurrence. Though there is a lack of literature to support the use of hydrodissection to treat vTOS, this was a specific case in which hydrodissection demonstrated to be an effective treatment modality. The specific utilization of hydrodissection should be studied more in order to increase the literature base and increase awareness of its potential effectiveness for this and similar conditions.