Vascular thoracic outlet syndrome. Longer posterior rib stump causes poor outcome

To assess the role of the relative length of the posterior rib stump in outcome after transaxillary first rib resection for thoracic outlet syndrome.

All patients with a transaxillary first rib resection between January 1990 and February 2004 were selected. Relative rib stump length was calculated by dividing the length of the posterior rib stump by the height of the 10th thoracic vertebra. Measurements were made on postoperative X-rays. Outcome was defined as excellent, good, fair, or poor.

Surgical outcome was excellent in 11 procedures (28.2%), good in 12 procedures (30.8%), fair in 9 (23.1%), and poor in 7 procedures (17.9%). Correlation of the outcome with the relative rib stump length gives a coefficient of .374 (P=.02). After exclusions of 3 patients with other medical conditions explanatory for remaining pain in the operated limb, the correlation coefficient was .614 (P<.01).

The relative length of the posterior rib stump is correlated with the outcome after transaxillary first rib resection in patients with thoracic outlet syndrome. First rib resection in patients with proven vascular compression should be as close as possible to the articulation with the transverse process, without injuring the brachial plexus.