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Transaxillary first rib resection for thoracic outlet syndrome

P W Cuypers1, E C Bollen, H P van Houtte

  • 1Department of General Surgery, De Wever Hospital, Heerlen, The Netherlands.

Acta Chirurgica Belgica
|May 1, 1995
PubMed
Summary

Transaxillary first rib resection for thoracic outlet syndrome (T.O.S.) shows limited success. This surgical treatment for T.O.S. was effective in only 52% of patients, suggesting conservative approaches may be more beneficial.

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Area of Science:

  • Vascular Surgery
  • Neurosurgery
  • Thoracic Surgery

Background:

  • Surgical treatment for thoracic outlet syndrome (T.O.S.) remains controversial.
  • Recent literature indicates moderate to poor outcomes following surgical intervention for T.O.S.
  • This study evaluates the efficacy of a specific surgical technique for T.O.S.

Purpose of the Study:

  • To assess the effectiveness of transaxillary first rib resection in treating thoracic outlet syndrome (T.O.S.).
  • To determine the success rate and patient outcomes following this surgical procedure for T.O.S.

Main Methods:

  • A retrospective analysis of 106 transaxillary first rib resections performed on 92 patients over twelve years.
  • Preoperative assessment included clinical evaluation, imaging (X-ray, duplex-ultrasonography, angiography), EMG, and neurological consultation.

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  • Follow-up was conducted on 85 patients (92%) by an independent observer, assessing symptom recurrence and return to pre-illness activity.

    • Main Results:

    • Neurological symptoms were predominant (63%), followed by arterial (22%) and venous (15%) T.O.S.
    • Only 52% of the first rib resection surgeries were deemed successful.
    • The remaining 48% of patients experienced either no improvement or worsening of their T.O.S. symptoms post-surgery.

    Conclusions:

    • Transaxillary first rib resection is often ineffective in relieving thoracic outlet syndrome (T.O.S.) symptoms.
    • The findings challenge previous reports and align with critical reviews suggesting limited surgical efficacy for T.O.S.
    • A greater emphasis on conservative management for T.O.S. is warranted, with surgery considered only as a last resort.