Two-surgeon approach to thoracic outlet syndrome: long-term outcome

An orthopaedic surgeon and a vascular surgeon jointly conducted 30 operatio ns for thoracic outlet syndrome in 27 patients, having done the preoperativ e assessments in conjunction with a neurologist. Anterior scalenectomy was performed by the supraclavicular route except in one case where the infracl avicular route was used. The further surgical procedure was tailored to the abnormalities identified-i.e. resection of cervical rib or band, or medial scalenectomy, The first rib was spared. At median follow-up of 37 months ( range 3-228) results were judged excellent or good on 26/30 sides (87%); on the three occasions when scalenectomy alone was performed, the results wer e only fair or poor, There were no major complications and no patient requi red reoperation. The long-term outcome in this series suggests that, with m ultidisciplinary assessment and two-surgeon operative treatment, good resul ts can be obtained by the supraclavicular route without resection of the fi rst rib.