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Recurrent thoracic outlet syndrome.

R J Sanders1, C E Haug, W H Pearce

  • 1Department of Surgery, Rose Medical Center, Denver, CO.

Journal of Vascular Surgery
|October 1, 1990
PubMed
Summary
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Reoperation for thoracic outlet syndrome recurrence is effective, with success rates improving over time, especially when recurrence follows trauma. Most patients experience symptom relief after surgical revision.

Area of Science:

  • Medical research
  • Surgical outcomes
  • Thoracic outlet syndrome

Background:

  • 15-20% of patients experience recurrent thoracic outlet syndrome (TOS) symptoms after initial surgery.
  • A significant number of reoperations for recurrent TOS have been performed over 22 years.
  • Four surgical approaches are utilized for recurrent TOS: transaxillary first rib resection, supraclavicular first rib resection with neurolysis, scalenectomy with neurolysis, and brachial plexus neurolysis.

Purpose of the Study:

  • To evaluate the efficacy and outcomes of different surgical reoperations for recurrent thoracic outlet syndrome.
  • To compare the success rates of various surgical techniques used for recurrent TOS.
  • To determine factors influencing the success of reoperations for recurrent TOS, such as cause of recurrence.

Main Methods:

Related Experiment Videos

  • Retrospective analysis of 134 reoperations in 97 patients over 22 years.
  • Categorization of reoperations into four distinct surgical procedures.
  • Life-table methods used to analyze long-term success rates of primary and secondary operations.

Main Results:

  • The combined primary success rate for recurrent TOS operations was 84% at 3 months, decreasing to 41% at 10-15 years.
  • No significant difference in recurrence rates was observed among the four surgical methods.
  • Reoperations showed better outcomes when recurrence was trauma-induced compared to spontaneous recurrence.
  • Reoperation improved the 5-10 year success rate for transaxillary first rib resection (69% to 86%) and scalenectomy (69% to 84%).

Conclusions:

  • Reoperation is a successful strategy for managing recurrent thoracic outlet syndrome.
  • Surgical outcomes for recurrent TOS are favorable, particularly when the recurrence is due to neck trauma.
  • Long-term success rates of reoperations demonstrate sustained improvement in symptom management for recurrent TOS patients.