Specialty Mediated 30-Day Complications in First Rib Resection for Thoracic Outlet Syndrome

Background: Thoracic outlet syndrome (TOS) is a complex entity resulting in neurogenic or vascular manifestations. A wide array of procedures has evolved, each with its own benefits and drawbacks. The authors hypothesized that treatment of TOS with first rib resection (FRR) may lead to increased complication rates. Methods: A retrospective case control study was performed on the basis of the National Surgical Quality Improvement Program database from 2005 to 2014. All cases involving the operative treatment of TOS were extracted. Primary outcomes included surgical and medical complications. Analyses were primarily stratified by FRR and secondarily by other procedure types. Results: A total of 1853 patients met inclusion criteria. The most common procedures were FRR (64.0%), anterior scalenectomy with cervical rib resection (32.9%), brachial plexus decompression (27.2%), and anterior scalenectomy without cervical rib resection (AS, 8.9%). Factors associated with increased medical complications included American Society of Anesthesiologists (ASA) classification of 3 or greater and increased operative time. The presence or absence of FRR did not influence complication rates. Conclusions: FRR is not associated with an increased risk of medical or surgical complications. Medical complications are associated with increased ASA scores and longer operative time.

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First Rib Resection for Thoracic Outlet Syndrome: The Robotic Approach

World Journal of Surgery ◽

10.1007/s00268-018-4636-4 ◽

2018 ◽

Vol 42 (10) ◽

pp. 3250-3255 ◽

Cited By ~ 8

Author(s):

Gregor J. Kocher ◽

Adrian Zehnder ◽

Jon A. Lutz ◽

Juerg Schmidli ◽

Ralph A. Schmid

Keyword(s):

Thoracic Outlet Syndrome ◽

Robotic Approach ◽

Rib Resection ◽

First Rib ◽

First Rib Resection

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Thoracic Outlet Syndrome: The Results of First Rib Resection in 100 Patients

Orthopedic Clinics of North America ◽

10.1016/s0030-5898(20)30337-0 ◽

1988 ◽

Vol 19 (1) ◽

pp. 131-146 ◽

Cited By ~ 3

Author(s):

Virchel E. Wood ◽

Randy Twito ◽

Joseph Michael Verska

Keyword(s):

Thoracic Outlet Syndrome ◽

Rib Resection ◽

First Rib ◽

First Rib Resection

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Arterial Thoracic Outlet Syndrome

10.2310/vasc.3070 ◽

2018 ◽

Author(s):

Besem Beteck ◽

John Eidt ◽

Bradley Grimsley

Keyword(s):

Subclavian Artery ◽

Thoracic Outlet Syndrome ◽

Computed Tomographic Angiography ◽

Rib Resection ◽

Computed Tomographic ◽

First Rib ◽

Arterial Complication ◽

Scalene Triangle ◽

First Rib Resection ◽

Arterial Thoracic Outlet Syndrome

Arterial thoracic outlet syndrome (TOS) is the least common form of TOS in adults. It is an entity that is associated with bony anomalies resulting in chronic subclavian artery compression. Most patients with arterial TOS are young adults presenting either with limb-threatening upper extremity ischemia or chronic symptoms suggestive of arterial insufficiency involving the extremity. Initial diagnostic evaluation involves chest radiography, which may reveal cervical or anomalous first rib. Catheter-based arteriography has a diagnostic as well as therapeutic role. Magnetic resonance angiography and computed tomographic angiography, which are readily available, can be used in surgical planning. Treatment involves revascularization of the extremity, subsequent first rib resection, and possible reconstruction of the subclavian artery. This review contains 4 figures, 1 table and 45 references Key Words: arterial complication, brachial thromboembolectomy, cervical rib, costoclavicular space, first rib resection, pectoralis minor space, scalene triangle, subclavian artery stenosis, thoracic outlet syndrome

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