770 CONSECUTIVE SUPRACLAVICULAR FIRST RIB RESECTIONS FOR THORACIC OUTLET SYNDROME

During a 28-year period, 637 patients underwent 770 supraclavicular fi rst rib resections and scalenectomies for thoracic outlet syndrome (TO S). The neurologic type of TOS was found in 705 cases (92%) and the re maining 65 cases (8%) had the vascular form of TOS. Of those extremiti es with brachial plexus irritation, the symptom complex consisted of p aresthesia in 30 (4%), pain in 221 (31%), and pain with paresthesia in 454 (64%). In the cases of vascular TOS, 47 limbs (6%) had venous com plications and 18 limbs (2%) had arterial sequelae. Following supracla vicular scalenectomy and rib resection, an excellent response was achi eved in 59% (455 cases) and a good result was achieved in another 27% (206 cases). A fair outcome was present in 13% (95 cases) and a poor r esult was found in only 1% (13 cases). There was a single occurrence o f lymphatic leakage and no brachial plexus injuries resulted. Postoper ative causalgia requiring subsequent sympathectomy developed in two ca ses. No vascular or permanent phrenic nerve injuries occurred and only 12 patients (2%) required operative intervention for recurrent TOS. F irst rib resection and scalenectomy can be performed by the supraclavi cular route with an acceptable outcome, minimal morbidity, and long-la sting results.