Outcome of Trans-Axillary Approach for Surgical Decompression of Thoracic Outlet: A Retrospective Study in a Tertiary Care Hospital

Abstract

Objective: The aim of this study was to evaluate the trans-axillary surgical approach in patients with thoracic outlet syndrome. Results: There were a total of 139 patients. The female: male ratio was about 6:1. Pain was the most common presenting symptom followed by weakness and parasthesia. Nerve conduction velocity was abnormal in 111 patients. Twenty-eight patients had abnormal Doppler study of subclavian vessels. Preoperative symptoms persisted in 13 patients. Overall, 126 patients showed improvement in symptoms and no recurrence or persistence of symptoms on follow-up examination. Conclusion: Trans-axillary approach provides a good exposure and cosmesis in patients with thoracic outlet syndrome. It should be considered as the gold standard in the management of thoracic outlet syndrome.

Trans-axillary approach in surgery for thoracic outlet syndrome

“…The great majority of cases are within the 2nd and the 4th decades [2-4, 7-9, 12]. Although some reports indicate a slight preference, female patients are more common [3,4,[7][8][9]12]. In our series the average age was 31.9±11.7 years, and there was a female predominance as 5.4:1.…”

“…Trans-axillary approach provides adequate surgical exposure for resection of the first rib, the cervical rib, if present, the soft tissue structures and membranes, and neurolysis in experienced hands. Complications are rare and limited to pneumothorax, vascular injury, nerve injury, and wound infection [1,[3][4][5][6][7][8][9][10][11][12]. In our series all patients were operated using trans-axillary approach.…”

“…Others advocate trans-axillary approach especially in female patients [3,[5][6][7][8][9][10]. Trans-axillary approach provides adequate surgical exposure for resection of the first rib, the cervical rib, if present, the soft tissue structures and membranes, and neurolysis in experienced hands.…”

“…According to patient complaints and symptoms, TOS can be classified as neurogenic (NTOS), arterial (ATOS), and venous TOS (VTOS) [1][2][3][4][5][6]. ATOS and VTOS may require correction of vascular anomalies and are beyond the scope of this study.…”

Assessment of Diagnosis and Treatment of Thoracic Outlet Syndrome, An Important Reason of Pain in Upper Extremity, Based on Literature

“…Lattoo et al applied transaxillary surgery on 139 patients with TOS and recovery was observed in symptoms of 123 patients and no recurrence was determined. In the second study; Lattoo et al have emphasized that transaxillary surgery was the golden standard in patients with TOS as it is very good for the patient in terms of cosmetics, it ensures a good exposure and surgical results are perfect [39]. In the 3 rd study, Atasoy combined both surgical procedures (removal of transaxillary first level and cut off of transcervical anterior and medium scalen) in patients with TOS and determined significant relief in complaints of patients [40].…”