Successful Return to Active Duty following First Rib Resection for Thoracic Outlet Syndrome
Kimberly A. Thompson, MD, Jeffrey S. Weiss, MD, Meghann E. Nelles, MD, Joseph D. Ayers, MD, Kevin M. Casey, MD.
Naval Medical Center San Diego, San Diego, CA, USA.
Introduction and Objectives: The optimal surgical approach and treatment algorithm for thoracic outlet syndrome (TOS) remain controversial. We sought to examine the outcomes of patients treated at a military treatment facility (MTF) for TOS.
Methods: A retrospective review was performed on all patients who had a first rib resection (FRR) for TOS over a 10 year period at a single MTF. Patient demographics, perioperative details, and patient outcomes were examined. Active duty (AD) status and return to AD were reviewed.
Results: From 2008-2016, 30 FRRs were performed. Of these, 27 patients were AD with a mean age of 27 years (range, 19 - 44). The 24 male and 3 female patients were treated for symptoms of venous (18), neurogenic (7), or arterial (2) TOS.
FRR was performed via a transaxillary (12), supraclavicular (11), or paraclavicular (6) approach. Of 18 AD patients with venous TOS, 13 (72%) underwent preoperative thrombolysis. Vein patency was documented in 16 (88%) patients. Nine patients underwent subsequent venoplasty or stent placement. Fifteen (83%) patients were placed on anticoagulation (AC) for an average of 12 weeks (range, 1-26).
Four AD patients had perioperative complications including post-op bleed (2), lymph leak, and brachial plexus palsy. Twenty-four (89%) patients returned to AD. A shorter duration of anticoagulation (<90 days vs. >/= 90 days) was associated with a quicker return to AD (median, 42 vs. 119 days), with equivalent vein patency rates. Two sailors did not return to AD for reasons unrelated to their surgery.
Conclusions: Despite the variability in surgical approaches, a technique tailored to each patient’s presentation resulted in a high percentage of post-operative vein patency and return to AD status. Shortening AC duration hastens return to AD without sacrificing vein patency. AD patients with TOS should be treated like competitive athletes and can have similar outcomes.
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