• J. Am. Coll. Surg. · May 2015

    A decade of excellent outcomes after surgical intervention in 538 patients with thoracic outlet syndrome.

    • Megan S Orlando, Kendall C Likes, Serene Mirza, Yue Cao, Anne Cohen, Ying Wei Lum, Thomas Reifsnyder, and Julie A Freischlag.
    • Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, MD. Electronic address: morlando@jhmi.edu.
    • J. Am. Coll. Surg. 2015 May 1; 220 (5): 934-9.

    BackgroundOur aim was to evaluate the outcomes of patients who underwent first rib resection (FRR) for all 3 forms of thoracic outlet syndrome (TOS) during a period of 10 years.Study DesignPatients treated with FRR from August 2003 through July 2013 were retrospectively reviewed using a prospectively maintained database.ResultsFive hundred and thirty-eight patients underwent 594 FRRs for indications of neurogenic (n = 308 [52%]), venous (n = 261 [44%]), and arterial (n = 25 [4%]) TOS. Fifty-six (9.4%) patients had bilateral FRR. Fifty-two (8.8%) patients had cervical ribs. Three hundred and ninety-eight (67%) FRRs were performed on female patients, with a mean age of 33 years (range 10 to 71 years). Three hundred and forty (57%) were right-sided procedures. Seventy-five children (aged 18 years or younger) underwent FRRs; 25 during the first 5 years and 50 during the second 5 years. When comparing the second 5-year period with the first 5-year period, more patients had venous TOS (48% vs 37%; p < 0.02); fewer patients had neurogenic TOS (48% vs 58%; p < 0.05), and improved or fully resolved symptoms increased from 93% to 96%. Complications included 2 vein injuries, 2 hemothoraces, 4 hematomas, 138 pneumothoraces (23%), and 8 (1.3%) wound infections. Mean length of stay was 1 day.ConclusionsExcellent results were seen in this surgical series of neurogenic, venous, and arterial TOS due to appropriate selection of neurogenic patients, use of a standard protocol for venous patients, and expedient intervention in arterial patients. There is an increasing role for surgical intervention in children.Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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