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Transaxillary First Rib Resection for Treatment of the Thoracic Outlet Syndrome
Published on: September 13, 2020
Neurovascular compression in the thoracic outlet: changing management over 50 years
1University of Texas Southwestern Medical School, Baylor University Medical Center, Dallas, USA.
Annals of Surgery
|October 28, 1998
Summary
Thoracic outlet syndrome (TOS) treatment improved with first rib removal, effectively decompressing nerves and improving vascular TOS symptoms. Hyaluronic acid use also reduced scarring in recurrent cases.
Area of Science:
- Vascular Surgery
- Neurosurgery
- Thoracic Surgery
Background:
- Thoracic outlet syndrome (TOS) diagnosis and treatment have advanced over 50 years.
- TOS is often linked to sports, breast implants, or median sternotomy.
- Over 15,000 patients have been evaluated for TOS, with many undergoing surgical intervention.
Purpose of the Study:
- To evaluate the effectiveness of neurovascular decompression for TOS.
- To analyze outcomes of primary and secondary surgical procedures for TOS.
- To assess different surgical approaches for TOS, including first rib resection.
Main Methods:
- Analysis of over 15,000 patient evaluations for TOS.
- Review of 3914 primary and 1221 secondary neurovascular decompression procedures.
- Assessment of transaxillary first rib removal for neurovascular decompression.
- Evaluation of surgical outcomes for axillary subclavian artery aneurysms/occlusions and Paget-Schroetter syndrome.
Main Results:
- Transaxillary first rib removal alone effectively treated both upper and lower plexus compression symptoms.
- 240 patients with axillary subclavian artery aneurysm or occlusion had successful treatment.
- 211 patients with effort thrombosis (Paget-Schroetter syndrome) showed excellent long-term results after thrombolysis and first rib resection.
- Hyaluronic acid use significantly reduced recurrent scarring in 1221 patients undergoing secondary procedures.
Conclusions:
- Transaxillary first rib removal is a key procedure for TOS, addressing both neurogenic and vascular components.
- Surgical decompression, including first rib resection, offers effective treatment for various TOS presentations.
- Prompt intervention for effort thrombosis combined with first rib resection yields excellent outcomes.
- Adjuvant therapies like hyaluronic acid can improve outcomes in recurrent TOS cases.
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