Thoracic Outlet Syndrome

Message from the Director

Dear patients and colleagues:

Exterior image of the hospital building.I have been here at the Dialysis Access Institute, part of the Regional Medical Center in Orangeburg, SC, for almost a year. I have been extraordinarily lucky to practice at, and be an integral part of, the largest and highest volume arteriovenous access center in the world. We are working hard on trying to take what we have experienced here to the next level academically, educationally, and in a business sense.

Based on our volume, what I am trying to do with arteriovenous access in general, and the logistical challenges inherent in the fact that we are not a large urban academic medical center, after much advice and reflection I have decided that I will no longer be treating neurogenic, conventional venous, or arterial thoracic outlet syndrome. As a world leader in complex arteriovenous access, we do have a very active surgical and endovascular program in place for patients on dialysis who have obstructed outflow, so I will continue to treat this problem when associated with (and causing problems with) arteriovenous access.

I will continue to play an active role in the evolution of the diagnosis and treatment of thoracic outlet syndrome, but only in an academic and educational sense (we are nearing completion of the second edition of our textbook, Thoracic Outlet Syndrome (Springer), anticipating publication in early 2020). To all those I have helped, or tried to help: Thank you for entrusting me with your problems. And to any who are looking for help: at this point I just cannot do you justice, but we are always most willing to recommend other resources.

For those of you on dialysis with a swollen arm, or for those nephrologists who recognize this problem in their patients: We are here to try to fix the problem. Blockage due to compression of the vein at the costoclavicular junction, where the first rib and clavicle come together, responds very well to bony decompression. With over a hundred cases done to date, we have achieved a fistula salvage rate of approximately 90%. More information can be found in the references cited, but our program is specifically focused on solving this problem.

Karl A. Illig, MD
Director, Thoracic Outlet Center
Regional Medical Center

Thoracic Outlet Syndrome Location