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DOI: 10.1055/s-0030-1250480
© Georg Thieme Verlag KG Stuttgart · New York
Transaxillary Approach for Thoracic Outlet Syndrome: Results of Surgery
Publikationsverlauf
received April 9, 2010
Publikationsdatum:
15. März 2011 (online)
![](https://www.thieme-connect.de/media/thoracic/201106/lookinside/thumbnails/10.1055-s-0030-1250480-1.jpg)
Abstract
Background: Thoracic outlet syndrome (TOS) is one of the most complicated diseases in thoracic surgery with regard to both diagnosis and treatment. Surgical removal of the first rib and cervical rib, if present, has been suggested as the treatment of choice in patients who do not benefit from physiotherapy. In this retrospective study, our surgical experience with TOS and the management of surgical complications are presented. Methods: A total of 109 cases with the diagnosis of TOS were operated on between January 1995 and April 2010. Ninety-five of the cases were females (87.2 %) and 14 (12.8 %) were males with a mean age of 35.7 (16–58). Results: A total of 131 operations were performed, of which 21 were bilateral and one was a recurrent operation. The diagnosis was neurogenic TOS in 107 (98.2 %) and vascular TOS in two (1.8 %) patients. All neurogenic TOS operations were performed via the transaxillary route. A posterior thoracoplasty approach was used for recurrent TOS in one case. A total of 23 (21.1 %) cases had a cervical rib. Fibromuscular bands were observed in 68 (62.3 %) cases. The rates for favorable and poor surgical outcome were 125 (95.4 %) and 6 (4.6 %), respectively. The most common complication was apical pneumothorax in 32 (24.6 %) cases, followed by wound infection in four (3 %), lymphatic leak, axillary hematoma and mild brachial plexus traction palsy in one (0.8 %) case. Mortality was not observed. Conclusions: In our experience the exposure provided by the transaxillary approach is safe and superior to that offered by other approaches as it allows a wide range of surgical applications such as first rib resection, cervical rib resection and resection of fibrotic bands.
Key words
thoracic surgery - thoracic outlet - surgery - thoracic outlet syndrome - surgical outcome - transaxillary approach - complications
References
- 1 Han S, Yildirim E, Dural K, Ozisik K, Yazkan R, Sakinci U. Transaxillary approach in thoracic outlet syndrome: the importance of resection of the first-rib. Eur J Cardiothorac Surg. 2003; 24 428-433
- 2 Rob C G, Standaven A. Arterial occlusion complicating thoracic outlet compression syndrome. Br Med J. 1958; 2 709-712
- 3 Roos D B. Historical perspectives and anatomical considerations. Semin Thorac Cardiac Surg. 1996; 8 183-189
- 4 Scandalakis J E, Mirilas P. Benign anatomical mistakes: the thoracic outlet syndrome. Am Surg. 2001; 67 1007-1010
- 5 Roos D B. The place of scalenectomy and first rib resection in thoracic outlet syndrome. Surgery. 1982; 92 1077-1085
- 6 Novak C B, Collins E D, Mackinnon S E. Outcome following conservative management of thoracic outlet syndrome. J Hand Surg Am. 1995; 20 542-548
- 7 Povlsen B, Belzberg A, Hansson T, Dorsi M. Treatment for thoracic outlet syndrome (review). The Cochrane Collaboration Library. 2010; (1) 1-13
- 8 Yavuzer S, Atinkaya C, Tokat O. Clinical predictors of surgical outcome in patients with thoracic outlet syndrome operated on via transaxillary approach. Eur J Cardiothorac Surg. 2004; 25 173-178
- 9 Roussef R, Tzvetanov P, Valkov I. Utility (or futility?) of electrodiagnosis in thoracic outlet syndome. Elektromyogr Clin Neurophysiol. 2005; 45 131-133
- 10 Roos D B. Transaxillary approach for first rib resection to relieve thoracic outlet syndrome. Ann Surg. 1966; 163 354-358
- 11 Urschel H C. The transaxillary approach for treatment of thoracic outlet syndromes. Semin Thorac Cardiac Surg. 1996; 8 214-220
- 12 Cheng S W K, Stoney R J. Supraclavicular reoperation for neurogenic thoracic outlet syndrome. J Vasc Surg. 1994; 19 565-572
- 13 Urschel H C, Razzuk M A. Paget-Schroetter syndrome: what is the best management?. Ann Thorac Surg. 2000; 69 1663-1668
- 14 Sanders R J, Hammond S L, Rao N M. Observations on the use Seprafilm on the brachial plexus in 249 operations for neurogenic thoracic outlet syndrome. Hand. 2007; 2 179-183
- 15 Sanders R J, Hammond S L. Management of cervical ribs and anomalous first ribs causing neurogenic thoracic outlet syndrome. J Vasc Surg. 2002; 36 51-56
- 16 Sanders R J. Results of the surgical treatment for thoracic outlet syndrome. Semin Thorac Cardiac Surg. 1996; 8 221-227
- 17 Toso C, Robert J, Berney T, Pugin F, Spiliopoulos A. Thoracic outlet syndrome: influence of personal history and surgical technique on long-term results. Eur J Cardiothorac Surg. 1999; 16 44-47
- 18 Mingoli A, Feldhaus R J, Farina C et al. Long term outcome after transaxillary approach for thoracic outlet syndrome. Surgery. 1995; 118 840-844
- 19 Machinnon S E, Patterson G A. Supraclavicular first rib resection. Semin Thorac Cardiac Surg. 1996; 8 208-213
- 20 Balci A E, Balci T A, Cakir O, Eren S, Eren M N. Surgical treatment of thoracic outlet syndrome: effect and results of surgery. Ann Thorac Surg. 2003; 75 1091-1096
- 21 Chang D C, Rotellini-Coltvet L A, Mukherjee D, De Leon R, Freischlag J A. Surgical intervention for thoracic outlet syndrome improves patient's quality of life. J Vasc Surg. 2009; 49 (3) 630-635
Dr. Yekta Altemur Karamustafaoglu, MD
Department of Thoracic Surgery
Trakya University
Faculty of Medicine
Trakya universitesi tip fakultesi, Gogus cerrahi Ad kat:4
22030 Edirne
Turkey
Telefon: +90 28 42 35 59 36
Fax: +90 28 42 35 59 36
eMail: altemurk@hotmail.com