Thoracic Outlet Syndrome Diagnosis, Treatment and Outcomes; Retrospective review in a single institution of 42 surgical procedures.
Erion Qaja, DO, Parth Shah, MD, Thomas Divinagracia, MD.
U Conn/Hartford Hospital, Hartford, CT, USA.
Objective
Thoracic outlet syndrome (TOS) is compression of neurovascular structures in the thoracic outlet with signs and symptoms dependent on compression of the predominant structure. The purpose of this study is to evaluate outcomes of surgical decompression of TOS in patients with symptomatic venous, neurogenic and arterial TOS in our institution since the establishment of Thoracic Outlet Syndrome Center.
Methods
A retrospective analysis of patients undergoing surgical decompression of the thoracic outlet after establishment of a Thoracic Outlet Center was performed. The cases of venous thoracic outlet syndrome comprised of initial presentation with effort thrombosis of the subclavian vein undergoing catheter-directed thrombolysis therapy followed by surgical decompression of TOS. The cases of nTOS involved a multidisciplinary approach in diagnosis and treatment with a trial of physical therapy. The outcomes were evaluated at 3 weeks, 3 months and yearly post procedure in TOS clinic.
Results
From July 2013 to September 2018, 42 surgical procedures performed for venous TOS (29), neurogenic TOS (11), and arterial TOS (2). There were two patients with bilateral procedures; one for venous and the second neurogenic. The predominant surgical approach for vascular TOS was paraclavicular (93%; 29/31) while the nTOS cases were approached via supraclavicular incision (82%, 9/11). Both the patients presenting with aTOS had presence of cervical rib and required replacement of the subclavian artery. FRR was performed in 97% of cases (41/42) with 1 case of aTOS with cervical rib resection and anterior scalenectomy alone (3%). Primary patency of vascular reconstruction was 93%) with reintervention rate of 3%. Recurrence rate in nTOS was 9% (1/11). There were two (5%) cases that had prior trans-sternal rib resection.
Please refer to Table 1.
Conclusion
In our experience, surgical treatment of TOS with paraclavicular approach is beneficial and safe in the patients with vTOS, nTOS and aTOS patients. Majority of the patients enjoy excellent symptomatic relief with good functional outcomes.
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