Thoracic outlet syndrome surgery: long-term functional results.

Area of Science:

• Vascular Surgery
• Neurosurgery
• Thoracic Surgery

Background:

• The long-term outcomes of thoracic outlet syndrome (TOS) surgery are not well-documented.
• TOS treatment remains controversial, necessitating further investigation into surgical results.

Purpose of the Study:

• To assess the 2-year clinical outcomes following TOS surgery.
• To identify predictive factors influencing the success of TOS surgical interventions.

Main Methods:

• Retrospective review of 176 TOS surgical procedures performed between 1979 and 1999.
• Patient data including presenting symptoms, surgical approach (transaxillary or supraclavicular), and first rib resection extent were analyzed.
• Functional outcomes were assessed via phone survey using Derkash's classification at a minimum 2-year follow-up.

Main Results:

• Overall functional results were excellent or good in 84% of procedures.
• Predictors of negative outcomes included acute ischemia, neurological deficits, poorly systematized neurological symptoms, extensive first rib resection, and severe postoperative complications.
• Patients with poorly systematized neurological symptoms had significantly poorer outcomes.

Conclusions:

• TOS surgery yields satisfactory 2-year results for the majority of patients.
• Careful patient selection, particularly avoiding surgery for poorly systematized neurological symptoms, is crucial.
• Partial first rib resection and meticulous surgical technique minimizing complications are key to successful long-term outcomes.