How I do it. Thoracic outlet syndrome and the transaxillary approach

Area of Science:

• Vascular Surgery
• Neurology
• Thoracic Surgery

Background:

• Thoracic outlet syndrome (TOS) is characterized by compression of neurovascular structures within the thoracic outlet.
• Initially described in relation to cervical ribs, TOS is now understood to encompass arterial, venous, and neurogenic presentations.
• Neurogenic TOS accounts for the vast majority of cases (95%), with venous (3%) and arterial (1%) TOS being less common.

Purpose of the Study:

• To present a comprehensive evaluation, diagnosis, and management strategy for patients with thoracic outlet syndrome.
• To highlight the distinct clinical presentations and treatment requirements for arterial, venous, and neurogenic TOS.
• To emphasize the utility of the transaxillary approach in managing TOS.

Main Methods:

• Systematic review of TOS diagnostic and management strategies.
• Clinical case evaluation focusing on patient presentation and diagnostic workup.
• Surgical technique description, particularly the transaxillary approach.

Main Results:

• Detailed breakdown of diagnostic criteria for arterial, venous, and neurogenic TOS.
• Discussion of the incidence rates for each TOS subtype.
• Emphasis on the effectiveness of the transaxillary approach for TOS treatment.

Conclusions:

• Thoracic outlet syndrome requires specialized diagnostic and management expertise tailored to its specific subtype (arterial, venous, or neurogenic).
• The transaxillary approach offers a viable surgical option for TOS management.
• Accurate diagnosis and subtype-specific treatment are crucial for optimal patient outcomes in TOS.