Evaluation of Complications after Surgical Treatment of Thoracic Outlet Syndrome

Abstract

BackgroundSurgical treatment of thoracic outlet syndrome (TOS) is necessary when non-surgical treatments fail. Complications of surgical procedures vary from short-term post-surgical pain to permanent disability. The outcome of TOS surgery is affected by the visibility during the operation. In this study, we have compared the complications arising during the supraclavicular and the transaxillary approaches to determine the appropriate approach for TOS surgery.MethodsIn this study, 448 patients with symptoms of TOS were assessed. The male-to-female ratio was approximately 1:4, and the mean age was 34.5 years. Overall, 102 operations were performed, including unilateral, bilateral, and reoperations, and the patients were retrospectively evaluated. Of the 102 patients, 63 underwent the supraclavicular approach, 32 underwent the transaxillary approach, and 7 underwent the transaxillary approach followed by the supraclavicular approach. Complications were evaluated over 24 months.ResultsThe prevalence of pneumothorax, hemothorax, and vessel injuries in the transaxillary and the supraclavicular approaches was equal. We found more permanent and transient brachial plexus injuries in the case of the transaxillary approach than in the case of the supraclavicular approach, but the difference was not statistically significant. Persistent pain and symptoms were significantly more common in patients who underwent the transaxillary approach (p<0.05).ConclusionThe supraclavicular approach seems to be the more effective technique of the two because it offers the surgeon better access to the brachial plexus and a direct view. This approach for a TOS operation offers a better surgical outcome and lower reoperation rates than the transaxillary method. Our results showed the supraclavicular approach to be the preferred method for TOS operations.

Pneumothorax, pneumomediastinum, and dysphonia complicating awake transcarotid artery revascularization

“…Pneumothorax after dissection low in the neck for vascular procedures is not uncommon and occurs frequently during operations for thoracic outlet syndrome using a supraclavicular incision. 5 In contradistinction to this case, rib resectionrelated pneumothorax is most often caused by direct pleural violation, which is often visualized during the course of the procedure. Other procedures involving dissection in the low neck similar to TCAR include carotid-subclavian bypass and subclavian transposition performed for a variety of indications.…”

Thoracic Outlet Syndrome: A Comprehensive Review of Pathophysiology, Diagnosis, and Treatment

“…In a multi-institution database study, brachial plexus injuries were reported in 0.6% patients with nTOS following transaxillary first rib resection [50]. However, another study of transaxillary first rib resections in patients with nTOS reported a brachial plexus injury incidence of 9%, with an incidence of 4% after supraclavicular first rib resection [51].…”

The Diagnosis and Treatment of a Rare Case of Supraclavicular Neuropathy Following Thoracic Decompression Surgery

“…A review of available literature did reveal a retrospective study specifically comparing complications of the transaxillary and supraclavicular approaches (n=102) [9]. They found no significant difference in the prevalence of pneumothorax, hemothorax, vascular injury, or plexus injury between the 2 approaches.…”