Thoracic outlet syndrome: influence of personal history and surgical technique on long-term results

Objective: Long-term results after surgery for thoracic outlet syndrome (TO S) are reviewed in terms of personal histories and surgical techniques. Met hods: Forty-eight operations were performed in 37 patients. In 21 instances , the picture was one of ordinary TOS, in eight TOS was traumatic and in ni ne the picture was sub-acute. Cervical ribs were excised through a supracla vicular approach tin seven cases), and first ribs through transthoracic, tr ansaxillary or supraclavicular approaches (in 25, 15 or one, respectively). Long-term follow-up was obtained in 41 cases and averaged 11.7 years. Resu lts: Surgical decompression was successful in 28 cases (68%), including all patients with traumatic TOS (8/8) and seven with sub-acute symptoms (7/9). Outcome was good in five of seven supraclavicular cervical rib resections, and in 23 of 34 first rib excisions. First rib resections performed transa xillary had shorter post-operative stays, fewer complications. Conclusion: Surgical decompression is more successful when TOS is traumatic or sub-acut e. When involved, a cervical rib can be resected through a supraclavicular approach, since the procedure is easy and has little morbidity. The transax illary approach should be preferred for first rib resections because of sho rter post-operative stays and fewer complications than after the transthora cic approach. (C) 1999 Elsevier Science B.V. All rights reserved.