scholarly journals Not All Rib Resections Are Considered Equal: A Case of Successful Paraclavicular Surgical Decompression for Recurrent Venous Thoracic Outlet Syndrome

2018 ◽  
Vol 68 (3) ◽  
pp. e52
Author(s):  
Luke O. Pesonen ◽  
Edward L. Kreimier ◽  
Miles W. Jackson ◽  
Michael J. Heidenreich ◽  
Abdulhameed Aziz
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Surgical Decompression

scholarly journals Thirty-Day Outcomes Following Surgical Decompression of Thoracic Outlet Syndrome

Hand ◽  
2018 ◽  
Vol 14 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Talha Maqbool ◽  
Christine B. Novak ◽  
Timothy Jackson ◽  
Heather L. Baltzer
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Thoracic Outlet Syndrome ◽  
Surgical Decompression ◽  
Care Utilization ◽  
Improvement Program ◽  
Thoracic Inlet ◽  
Cervical Rib ◽  
Rib Resection ◽  
Hospital Stays

Background: Surgical thoracic outlet syndrome (TOS) management involves decompression of the neurovascular structures by releasing the anterior and/or middle scalene muscles, resection of the first and/or cervical ribs, or a combination. Various surgical approaches (transaxillary, supraclavicular, infraclavicular, and transthoracic) have been used with varying rates of complications. The purpose of this study was to evaluate early postoperative outcomes following surgical decompression for TOS. We hypothesized that first and/or cervical rib resection would be associated with increased 30-day complications and health care utilization. Methods: The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for all TOS cases of brachial plexus surgical decompression in the region of the thoracic inlet from 2005 to 2013. Results: There were 225 patients (68% females; mean age: 36.4 years ± 12.1; 26% body mass index [BMI] ⩾ 30). There were 205 (91%) patients who underwent first and/or cervical rib resection (±scalenectomy), and 20 (9%) underwent rib-sparing scalenectomy. Compared with rib-sparing scalenectomy, rib resection was associated with longer operative time and hospital stays ( P < .001). In the 30 days postoperatively, 8 patients developed complications (rib-scalenectomy, n = 7). Only patients with rib resection returned to the operating room (n = 10) or were readmitted (n = 9). Conclusions: Early postoperative complications are infrequent after TOS decompression. Rib resection is associated with longer surgical times and hospital stays. Future studies are needed to assess the association between early and long-term outcomes, surgical procedure, and health care utilization to determine the cost-effectiveness of the various surgical interventions for TOS.

Outcomes following operative management of thoracic outlet syndrome in the pediatric patients

Vascular ◽  
2018 ◽  
Vol 26 (4) ◽  
pp. 410-417 ◽  
Author(s):  
Jesus M Matos ◽  
Lorena Gonzalez ◽  
Elias Kfoury ◽  
Angela Echeverria ◽  
Carlos F Bechara ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Thoracic Outlet Syndrome ◽  
Pediatric Patients ◽  
Treatment Success ◽  
Surgical Decompression ◽  
Rib Resection ◽  
First Rib ◽  
Temporary Arteriovenous Fistula ◽  
Clinical Records ◽  
First Rib Resection

Objectives Thoracic outlet syndrome, a condition commonly reported in adults, occurs infrequently in the pediatric population. The objective of this study was to assess the outcome of surgical interventions of thoracic outlet syndrome in pediatric patients. Methods Clinical records of all pediatric patients with thoracic outlet syndrome who underwent operative repair from 2002 to 2015 in a tertiary pediatric hospital were reviewed. Pertinent clinical variables and treatment outcomes were analyzed. Results Sixty-eight patients underwent a total of 72 thoracic outlet syndrome operations (mean age 15.7 years). Venous, neurogenic, and arterial thoracic outlet syndromes occurred in 39 (57%), 21 (31%), and 8 (12%) patients, respectively. Common risk factors for children with venous thoracic outlet syndrome included sports-related injuries (40%) and hypercoagulable disorders (33%). Thirty-five patients (90%) with venous thoracic outlet syndrome underwent catheter-based interventions followed by surgical decompression. All patients underwent first rib resection with scalenectomy via either a supraclavicular approach (n = 60, 88%) or combined supraclavicular and infraclavicular incisions (n = 8, 12%). Concomitant temporary arteriovenous fistula creation was performed in 14 patients (36%). Three patients with arterial thoracic outlet syndrome underwent first rib resection with concomitant subclavian artery aneurysm repair. The mean follow-up duration was 38.4 ± 11.6 months. Long-term symptomatic relief was achieved in 94% of patients. Conclusions Venous thoracic outlet syndrome is the most common form of thoracic outlet syndrome in children, followed by neurogenic and arterial thoracic outlet syndromes. Competitive sports-related injuries remain the most common risk factor for venous and neurogenic thoracic outlet syndromes. Temporary arteriovenous fistula creation was useful in venous thoracic outlet syndrome patients in selective children. Surgical decompression provides durable treatment success in children with all subtypes of thoracic outlet syndrome.

scholarly journals Combination treatment of venous thoracic outlet syndrome: Open surgical decompression and intraoperative angioplasty

2004 ◽  
Vol 40 (4) ◽  
pp. 599-603 ◽  
Author(s):  
Darren B. Schneider ◽  
Paul J. Dimuzio ◽  
Niels D. Martin ◽  
Roy L. Gordon ◽  
Mark W. Wilson ◽  
...  
Keyword(s):  
Combination Treatment ◽  
Thoracic Outlet Syndrome ◽  
Surgical Decompression ◽  
Intraoperative Angioplasty

scholarly journals Bilateral Upper Extremity DVT in a 43-Year-Old Man: Is It Thoracic Outlet Syndrome?!

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Hadoun Jabri ◽  
Sarbajit Mukherjee ◽  
Devang Sanghavi ◽  
Shyam Chalise
Keyword(s):  
Upper Extremity ◽  
Subclavian Vein ◽  
Thoracic Outlet Syndrome ◽  
Rare Condition ◽  
Surgical Decompression ◽  
Upper Extremities ◽  
Vein Thrombosis ◽  
First Case ◽  
Arm Swelling ◽  
Deep Vein

Recurrent deep venous thrombosis, involving bilateral upper extremities, is an extremely rare phenomenon. We are presenting a 43-year-old man who was diagnosed with left upper extremity deep vein thrombosis (UEDVT) and was treated with anticoagulation and surgical decompression in 2004. 9 years later, he presented with right arm swelling and was diagnosed with right UEDVT using US venous Doppler. Venogram showed compression of the subclavian vein by the first rib, diagnosing thoracic outlet syndrome (TOS). He was treated with anticoagulation and local venolysis and later by surgical decompression of the subclavian vein. Bilateral UEDVT, as mentioned above, is an extremely rare condition that is uncommonly caused by TOS. To our knowledge, we are reporting the first case of bilateral UEDVT due to TOS. Diagnosis usually starts with US venous Doppler to detect the thrombosis, followed by the gold standard venogram to locate the area of obstruction and lyse the thrombus if needed. The ultimate treatment for TOS remains surgical decompression of the vascular bundle at the thoracic outlet.

Novel Surgical Approach for Decompression of the Scalene Triangle in Neurogenic Thoracic Outlet Syndrome

2018 ◽  
Vol 34 (05) ◽  
pp. 315-320 ◽  
Author(s):  
Joseph Ricci ◽  
Kyle Eberlin ◽  
Robert Hagan
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Surgical Intervention ◽  
Surgical Decompression ◽  
Outpatient Basis ◽  
Shoulder Dysfunction ◽  
Rib Resection ◽  
First Rib ◽  
Wide Range ◽  
Scalene Triangle ◽  
First Rib Resection

Thoracic outlet syndrome (TOS) is a cause of upper extremity and shoulder dysfunction. TOS can present with a wide range of symptoms due to compression of the brachial plexus or its branches during their passage through the cervicothoracobrachial region or scalene triangle. There are three types of TOS: arterial, venous, and neurogenic. Neurogenic TOS (nTOS) is by far the most frequent type and represents more than 95% of all cases. Historically, surgical intervention for all types of TOS has evolved based on the treatment for a vascular etiology and has typically included a first rib resection. Despite nTOS being by far the more common type, most previous interventions have not considered treatment via peripheral nerve decompression.We describe surgical treatment of nTOS, performed on an outpatient basis, which focuses on the surgical decompression of the structures associated with the scalene triangle in conjunction with release of the pectoralis minor insertion through limited incisions. The procedure avoids the morbidity associated with first rib resection and is successful in ameliorating nTOS symptoms. Further, we propose a nomenclature shift to scalene triangle syndrome (STS) to reflect the nerve and arterial compressions needing to be addressed.

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