Transaxillary First Rib Resection in Pediatric Patients with Thoracic Outlet Syndrome

Thoracic outlet syndrome (TOS), although rarer in children, can significantly impact quality of life. Although surgical management in the adult population is well reported, data on transaxillary first rib resection (TFRR) in the pediatric population is scarce. We aimed to assess the outcomes of TFRR in pediatric patients with TOS.

A retrospective review was performed on all patients aged 18 years or younger who underwent TFRR for symptomatic TOS at a single institution between 2012 and 2023. We described the treatment approach and long-term outcomes after TFRR.

TFRR was performed in 91 patients (median age 17 years [range 12-18 years], 66.7% female, and 85.3% Caucasian), including 42 neurogenic (nTOS), 51 venous (vTOS), 3 arterial (aTOS), and 6 mixed TOS. The median symptom duration was 735 days for nTOS and 52 days for vTOS. After a median follow-up of 13 months, 97.6% of nTOS patients reported symptomatic improvement and 55.2% of athletes returned to sports. In patients with vTOS, 86.0% demonstrated patent axillo-subclavian veins, 98.0% reported symptomatic improvement, and 72.7% of patients resumed athletic activities at last follow-up. For aTOS, all three patients experienced symptomatic improvement, with no arterial reconstruction required. In mixed TOS cases, patients similarly demonstrated favorable outcomes, including symptomatic improvement and vein patency. No major complications were observed in this series.

In this case series, we demonstrated that TFRR confers a benefit to patients with TOS in the pediatric age group, regardless of TOS type, with high rates of symptomatic improvement, return to sports, and minimal complications.