Mccleery’s Syndrome the Overlooked Cause of Swollen Upper Limb, Completion Venoplasty is The Key Word for Successful Surgical Decompression

Background: Venous thoracic outlet syndrome (VTOS) is the second most presenting pattern of thoracic outlet syndrome (TOS). Non thrombotic VTOS swollen upper limb is usually overlooked by many surgeons. When there is chronic intermittent arm swelling that is associated with discoloration that worsen with overhead arm movement, McCleery’s syndrome is more likely. Objective: We present the results of our treatment strategy of McCleery’s syndrome consisting of para-clavicular approach for thoracic outlet decompression (PCA-TOD), external venolysis, and combined surgical decompression with or without routine completion venoplasty. Patients and methods: A retrospective analysis of the data of twenty-three patients who presented from January 2016 to February 2021 with chronic intermittent arm swelling, we divided the patients into two groups, group (A): 13 patients who underwent surgical decompression alone and follow up. Group (B): 10 patients who underwent surgical decompression associated with Intraoperative venography and balloon angioplasty. Results: In group (A) complete symptomatic resolution was achieved in 6/13 (46.2%) patients, secondary endovenous intervention was required in 7 (53.8%) patients due to residual symptoms, postoperative average residual arm circumference difference was 0.92 ± 0.86 cm with a statistically significant difference in favor to group (B) (P value = 0.0274). In group (B) complete symptomatic cure achieved in 10/10 (100%) patients with statistically highly significant difference favoring to group (B) (P value = 0.0075). Conclusion: From our results, completion angioplasty of surgically decompressed axillo-subclavian venous segment added a significant cure and symptoms improvement for patients with McCleery’s syndrome and could be considered as a primary therapy in conjunction with surgical decompression.