Transaxillary Approach for Thoracic Outlet Syndrome: Results of Surgery

Karamustafaoglu, Y. A.; Yörük, Yener; Tarladacalisir, Taner; Kuzucuoğlu, Mustafa

doi:10.1055/s-0030-1250480

Cited by 33 publications

(14 citation statements)

References 14 publications

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“…Its proponents argue that it provides superior exposure for first rib resection, as well as for removal of cervical ribs and fibrous bands, with a more cosmetic scar. 31 Urschel et al, 37 in their review of TOS over 50 years, describe the transaxillary approach as their initial surgical approach through which they perform first rib and costoclavicular ligament resection, scalenectomy, and C7, C8, and T1 neurolysis. They argue that while first rib resection can be accomplished via the supraclavicular approach, visualization is inferior and requires retraction of the neurovascular structures.…”

Section: Transaxillarymentioning

confidence: 99%

Thoracic Outlet Syndrome

Kuhn

Lebus

Bible

2015

Journal of the American Academy of Orthopaedic Surgeons

133

154

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Thoracic outlet syndrome is a well-described disorder caused by thoracic outlet compression of the brachial plexus and/or the subclavian vessels. Neurogenic thoracic outlet syndrome is the most common manifestation, presenting with pain, numbness, tingling, weakness, and vasomotor changes of the upper extremity. Vascular complications of thoracic outlet syndrome are uncommon and include thromboembolic phenomena and swelling. The clinical presentation is highly variable, and no reproducible study exists to confirm the diagnosis; instead, the diagnosis is based on a physician's judgment after a meticulous history and physical examination. Both nonsurgical and surgical treatment methods are available for thoracic outlet syndrome. Whereas nonsurgical management appears to be effective in some persons, surgical treatment has been shown to provide predictable long-term cure rates for carefully selected patients. In addition, physicians who do not regularly treat patients with thoracic outlet syndrome may not have an accurate view of this disorder, its treatment, or the possible success rate of treatment.

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Section: Transaxillarymentioning

confidence: 99%

Thoracic Outlet Syndrome

Kuhn

Lebus

Bible

2015

Journal of the American Academy of Orthopaedic Surgeons

133

154

View full text Add to dashboard Cite

show abstract

“…The first rib is classically removed via either a transaxillary, supraclavicular, or infraclavicular approach. Although each approach has produced positive outcomes, the transaxillary approach is preferred to the clavicular counterparts in the setting of nTOS due to its rapid and easy exposure of the compressed structures, reducing the risk of injury [61,90,91]. However, the supraclavicular approach is more advantageous in the setting of aTOS, as it allows for easier resection of the first rib, cervical ribs, and other fibromuscular structures which may be compromising the subclavian artery.…”

Section: Surgical Managementmentioning

confidence: 99%

Thoracic Outlet Syndrome: A Narrative Review

Dierks

Vervaeke

et al. 2021

JCM

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Thoracic outlet syndrome comprises a group of disorders that result in compression of the brachial plexus and subclavian vessels exiting the thoracic outlet. Symptoms include pain, paresthesia, pallor, and weakness depending upon the compromised structures. While consensus in diagnostic criteria has not yet been established, a thorough patient history, physical exam, and appropriate imaging studies are helpful in diagnosis. General first-line therapy for thoracic outlet syndrome is a conservative treatment, and may include physical therapy, lifestyle modifications, NSAIDs, and injection therapy of botulinum toxin A or steroids. Patients who have failed conservative therapy are considered for surgical decompression. This article aims to review the epidemiology, etiology, relevant anatomy, clinical presentations, diagnosis, and management of thoracic outlet syndrome.

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“…6,7 Short-term outcomes related to the surgical management of TOS, however, are not fully described with most previously published studies reporting the experiences at single centers. [7][8][9][10][11][12] Furthermore, and perhaps due to a limited sample size/patient selection bias, existing studies report inconclusive findings regarding the complications or success rates among TOS subtypes. 12,13 The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) is a nationally validated, risk-adjusted data set that emerged as an initiative to improve the quality of surgical care and 30-day postoperative outcomes.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Outcomes of Thoracic Outlet Syndrome Surgical Repair in a Nationally Validated Database

Nejim

Alshaikh²,

Arhuidese

et al. 2016

Angiology

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We evaluated the occurrence of thoracic outlet syndrome (TOS) and 30-day postoperative outcomes. Patients undergoing cervical/first rib resection surgery were identified in the American College of Surgeons National Surgical Quality Improvement Program database (2005-2013). Thoracic outlet syndrome types were then examined. Propensity score matching was performed to account for potential confounders; 1180 patients were explored during the study period, 1007 (85.3%) were of the neurogenic TOS (NTOS), 32 (2.7%) patients had arterial TOS (ATOS), and 141 (12.0%) patients had venous TOS (VTOS). Patients with ATOS were significantly older (median age [interquartile range, IQR]-NTOS: 34 [25-44], ATOS: 49.5 [42.5-57], VTOS: 34 [23-43]; P < .001). Median operating time was significantly longer for patients with ATOS. Median in-hospital stay was also longer for patients with ATOS (median length of in-hospital stay [LOS; IQR]-NTOS: 2 [1-4]; ATOS: 6 [3-7]; and VTOS: 5 [2-7] days; P < .001). Patients with VTOS showed twice longer LOS when compared to NTOS after matching. Presentation and treatment of TOS have been studied extensively at highly experienced centers.

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Transaxillary Approach for Thoracic Outlet Syndrome: Results of Surgery

Abstract: In our experience the exposure provided by the transaxillary approach is safe and superior to that offered by other approaches as it allows a wide range of surgical applications such as first rib resection, cervical rib resection and resection of fibrotic bands.

Cited by 33 publications

References 14 publications

Thoracic Outlet Syndrome

Thoracic Outlet Syndrome

Thoracic Outlet Syndrome: A Narrative Review

Perioperative Outcomes of Thoracic Outlet Syndrome Surgical Repair in a Nationally Validated Database

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