Surgical treatment of thoracic outlet syndrome: effect and results of surgery

Clinical predictors of surgical outcome in patients with thoracic outlet syndrome operated on via transaxillary approach

“…The favorable rate of surgical outcome was 82.7% in our series, and it was comparable with other reports [8,9,11,12], however, we found that the presence of a cervical rib had a significant unfavorable effect on surgical outcome. Similarly, it has been reported that patients with cervical ribs undergoing surgery had a relatively worse surgical outcome, and this finding has been attributed to resecting the first rib, while leaving the cervical ribs in place [8].…”

“…Cervical ribs account for a rate of 7.5-9% in surgical cases [10]. One of the most significant findings of our data is possibly the high rate (63.8%) of patients with cervical rib compared to other series [4,8,11]. This finding may imply less frequent referring of patients without cervical rib for surgery.…”

“…Patients with shorter duration of symptoms had a 5-fold increased risk for a worse surgical outcome compared with patients with longer duration of symptoms. Most of the patients with TOS are admitted to hospitals for surgery when their symptoms are acute or severe [11]. Although we did not stratify the degree of symptoms such as arm pain and paresthesia which were present in 32 and 28% of patients in our series, respectively, we speculate that patients with longer duration of symptoms had mild symptoms which they could tolerate for a longer time.…”

“…It has been suggested that patients with UNCV values above 60 m/s usually improved from conservative physical therapy and those with UNCV values below this value were very likely to benefit from surgery [10]. Although the results were not compared with respect to surgical outcome, a recent study has shown that preoperative UNCV values had a significant increase in the post-operative period [11]. Our data showed that the presence of color Doppler findings did not have an effect on surgical outcome, however, the mean of UNCV values showed a significant difference with regard to surgical outcome ðP ¼ 0:001Þ: Similarly, the groups of UNCV dichotomized relative to the median value, which was 55 m/s, showed a significant difference in univariate analysis ðP ¼ 0:032Þ: Nevertheless, this significance disappeared in multivariate analysis ðP ¼ 0:307Þ: Moreover, we also found no significant difference between the groups with respect to surgical outcome ðP ¼ 0:761Þ (data not shown) when we analyzed our data dichotomized with regard to the UNCV level of 60 m/s.…”

Transaxillary Approach for Thoracic Outlet Syndrome: Results of Surgery

“…Injury to the intercostobrachial nerve will produce paresthesias in the distribution of this nerve, and care should be taken to identify the nerve at the beginning of the operation as it passes through the dome of the pleura [19]. Other complications such as pneumothorax, wound infection, or hematoma can be easily resolved [1,20]. Although hematomas can form around the brachial plexus, we think that the technique of opening the pleura to allow drainage into the pleural cavity rather than around the surgical site is not necessary.…”