LONG-TERM OUTCOME AFTER TRANSAXILLARY APPROACH FOR THORACIC OUTLET SYNDROME

Background. Recurrence or persistence of neurologic symptoms after sur gical treatment of patients with thoracic outlet syndrome (TOS) are re ported to be as high as 25 %. To identify factors affecting the long-t erm outcome of surgical treatment of patients with TOS, we reviewed ou r 20-year experience. Methods. One hundred thirty-four transaxillary f irst rib resections were performed on 118 patients (43 men, 75 women, mean age 38 +/- 13 years). Eighty-three operations (61.9%) were undert aken to relieve symptoms resulting from compression of the lower roots of the brachial plexus, 37 (27.6 %) for compression of both lower and upper roots, and 14 (10.5 %) for lower root and vascular symptoms. Al l patients underwent a transaxillary extraperiosteal first rib resecti on with transection of the scalene muscles. In 73 cases (54.5 %) a res ection of the anterior scalene muscle was also performed. A cervical r ib was removed in 28 cases (20.1 %), and anomalous fibrous bands adjac ent to the neurovascular bundle were resected in 41 cases (30.6 %). Re sults. No major complications were observed. Of 105 patients (118 proc edures) followed up (mean follow-up, 99 +/- 72 months), good to excell ent results were obtained in 96 cases (81.4%) and fair to poor results were recorded in 22 cases (18.6%). The presence of a long posterior f irst rib stump, measured from the chest x ray films, was the strongest determinant of the long-term results among the variables examined (p < 0.0001). Reoperation, consisting; of neurolysis and resection of the stump, was performed in 16 patients. The results were excellent in al l cases at a mean follow-up of 66 +/- 46 months. Primary and secondary 10-year actuarial freedom rates from recurrent symptoms were 80.9 % a nd 93.1 %, respectively. Conclusions. Our results suggest that the lon g-term outcome after surger for TOS was strongly influenced by the ext ent of the first rib resection.