Reoperation for Recurrent Thoracic Outlet Syndrome

Urschel, Harold C.; Razzuk, Maruf A.; Albers, John E.; Wood, Richard E.; Paulson, Donald L.

doi:10.1016/s0003-4975(10)64882-5

Cited by 52 publications

(24 citation statements)

References 6 publications

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“…Krusen (25) and Caldwell and coworkers (26) introduced the measurement of motor conduction velocities across the thoracic outlet in diagnosing TOS. Urschel and associates (27) popularized reoperation for recurrent TOS and thrombolysis with prompt transaxillary rib resection for PSS (28). Wilbourn (29) emphasized the controversial nature of neurogenic TOS without intrinsic muscle wasting.…”

Section: Historical Notementioning

confidence: 99%

Thoracic Outlet Syndrome: A 50-Year Experience at Baylor University Medical Center

Urschel

Kourlis²

2007

Baylor University Medical Center Proceedings

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During the past 5 decades, the recognition and management of thoracic outlet syndrome (TOS) have evolved. This article elucidates these changes and improvements in the diagnosis and management of TOS at Baylor University Medical Center. The most remarkable change over the past 50 years is the use of nerve conduction velocity to diagnose and monitor patients with nerve compression. Recognition that procedures such as breast implantation and median sternotomy may produce TOS has been revealing. Prompt thrombolysis followed by surgical venous decompression for Paget-Schroetter syndrome has markedly improved results compared with the conservative anticoagulation approach; thrombolysis and prompt first rib resection is the optimal treatment for most patients with Paget-Schroetter syndrome. Complete first rib extirpation at the initial procedure markedly reduces the incidence of recurrent neurologic symptoms or the need for a second procedure. Chest pain or pseudoangina can be caused by TOS. Dorsal sympathectomy is helpful for patients with sympathetic maintained pain syndrome or causalgia and patients with recurrent TOS symptoms who need a second procedure.

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Section: Historical Notementioning

confidence: 99%

Thoracic Outlet Syndrome: A 50-Year Experience at Baylor University Medical Center

Urschel

Kourlis²

2007

Baylor University Medical Center Proceedings

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“…Recommendations to use a posterior thoracotomy approach for recurrent thoracic outlet syndrome 17 or to combine a scalenectomy with first rib resection for recurrent thoracic outlet syndrome 18 suggest that there are patients in whom the pathophysiology is due to a problem other than in the region between the first rib and clavicle. The hypothesis tested in this study is that multiple sites of normal or anomalous anatomic structures may act as constraints to normal plexus excursion because of scarring from trauma, and may result in symptoms of brachial plexus compression: an extension of the double crush hypothesis.…”

mentioning

confidence: 99%

The Results of Supraclavicular Brachial Plexus Neurolysis (without First Rib Resection) in Management of Post-Traumatic “Thoracic Outlet Syndrome”

Dellon¹

1993

J reconstr Microsurg

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This study evaluated the effectiveness of a supraclavicular brachial plexus neurolysis, without a first rib resection, in relieving the symptom complex traditionally termed "thoracic outlet syndrome." The hypothesis to be tested was that patients with a history of trauma may sustain stretch-type injury and subsequent scarring in and about the brachial plexus which is left untreated during transaxillary first rib resection. This prospective study included 14 patients who each had a neurolysis of the five roots and three trunks of the brachial plexus, plus an anterior scalenectomy through a supraclavicular approach. The results were determined on 11 patients with a mean follow-up of 26.4 months. The results of surgery were five excellent (45 percent), five good (45 percent) and one who failed to improve (10 percent). It is concluded that, with a history of trauma, the symptom complex commonly referred to as "thoracic outlet syndrome" may be primarily due to entrapment of the brachial plexus at sites proximal to the interval between the first rib and the clavicle. It is suggested that: 1) the term "brachial plexus compression" best describes the syndrome without directing the surgeon to remove any one specific anatomic structure and 2) the supraclavicular approach permits excellent surgical exposure of the compressed neurovascular structures. An unexpected observation was the formation of the lower trunk from C8 and T1 proximal to the first rib in the majority of these patients.

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“…However, extrathoracic axillary tissue and muscles must still be dissected to obtain the first rib. In cases of recurrent TOS after operation, the posterior approach can potentially be used for reoperation (23).…”

Section: Discussionmentioning

confidence: 99%

Video-assisted thoracoscopic surgery for intrathoracic first rib resection in thoracic outlet syndrome

Hwang¹,

Min²,

Jo³

et al. 2017

J. Thorac. Dis.

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Reoperation for Recurrent Thoracic Outlet Syndrome

Cited by 52 publications

References 6 publications

Thoracic Outlet Syndrome: A 50-Year Experience at Baylor University Medical Center

Thoracic Outlet Syndrome: A 50-Year Experience at Baylor University Medical Center

The Results of Supraclavicular Brachial Plexus Neurolysis (without First Rib Resection) in Management of Post-Traumatic “Thoracic Outlet Syndrome”

Video-assisted thoracoscopic surgery for intrathoracic first rib resection in thoracic outlet syndrome

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