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Can Vascular Flow Change During Provocation Maneuvers Predict Surgical Failure in Neurogenic Thoracic Outlet
Ji Sup Hwang1, Changhyon Lee1, Jihyeung Kim1
1Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
Annals of Vascular Surgery
|April 16, 2025
Summary
Absent vascular flow during the costoclavicular maneuver in neurogenic thoracic outlet syndrome (NTOS) patients predicts surgical failure. This finding suggests considering first rib resection alongside scalenectomy for improved outcomes in NTOS.
Area of Science:
- Vascular Surgery
- Neurosurgery
- Thoracic Surgery
Background:
- Controversy exists regarding the necessity of simultaneous first rib resection during supraclavicular scalenectomy for neurogenic thoracic outlet syndrome (NTOS).
- Digital photoplethysmography is routinely used to assess vascular flow changes during provocation maneuvers.
- The study investigates if vascular flow changes predict surgical outcomes after isolated scalenectomy for NTOS.
Purpose of the Study:
- To determine if vascular flow changes during provocation maneuvers predict surgical failure in patients with NTOS undergoing isolated supraclavicular scalenectomy.
- To identify specific maneuvers and their associated vascular flow changes that correlate with surgical outcomes.
Main Methods:
- Fifty patients with NTOS underwent supraclavicular scalenectomy.
- Vascular flow was assessed using digital photoplethysmography during Roos, costoclavicular, and Adson maneuvers pre-operatively.
- Statistical analysis calculated adjusted odds ratios for surgical failure based on vascular flow changes, symptom duration, and electrodiagnostic findings.
Main Results:
- Mean vascular flow reductions were observed during provocation maneuvers: Roos test (46.0 ± 51.3%), costoclavicular maneuver (42.9 ± 48.2%), and Adson maneuver (85.4 ± 64.1%).
- Twenty-four percent of patients experienced surgical failure.
- Symptom duration (OR = 1.04) and absent vascular flow during the costoclavicular maneuver (OR = 23.30) were significant predictors of surgical failure.
Conclusions:
- Quantitative assessment of vascular flow changes during provocation maneuvers aids NTOS diagnosis and surgical treatment planning.
- Absent blood flow during the costoclavicular maneuver strongly predicts surgical failure.
- Simultaneous scalenectomy and first rib resection should be considered for NTOS patients with absent flow during the costoclavicular maneuver.
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