Outcomes following operative management of thoracic outlet syndrome in the pediatric patients

Vascular ◽  
2018 ◽  
Vol 26 (4) ◽  
pp. 410-417 ◽  
Author(s):  
Jesus M Matos ◽  
Lorena Gonzalez ◽  
Elias Kfoury ◽  
Angela Echeverria ◽  
Carlos F Bechara ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Thoracic Outlet Syndrome ◽  
Pediatric Patients ◽  
Treatment Success ◽  
Surgical Decompression ◽  
Rib Resection ◽  
First Rib ◽  
Temporary Arteriovenous Fistula ◽  
Clinical Records ◽  
First Rib Resection

Objectives Thoracic outlet syndrome, a condition commonly reported in adults, occurs infrequently in the pediatric population. The objective of this study was to assess the outcome of surgical interventions of thoracic outlet syndrome in pediatric patients. Methods Clinical records of all pediatric patients with thoracic outlet syndrome who underwent operative repair from 2002 to 2015 in a tertiary pediatric hospital were reviewed. Pertinent clinical variables and treatment outcomes were analyzed. Results Sixty-eight patients underwent a total of 72 thoracic outlet syndrome operations (mean age 15.7 years). Venous, neurogenic, and arterial thoracic outlet syndromes occurred in 39 (57%), 21 (31%), and 8 (12%) patients, respectively. Common risk factors for children with venous thoracic outlet syndrome included sports-related injuries (40%) and hypercoagulable disorders (33%). Thirty-five patients (90%) with venous thoracic outlet syndrome underwent catheter-based interventions followed by surgical decompression. All patients underwent first rib resection with scalenectomy via either a supraclavicular approach (n = 60, 88%) or combined supraclavicular and infraclavicular incisions (n = 8, 12%). Concomitant temporary arteriovenous fistula creation was performed in 14 patients (36%). Three patients with arterial thoracic outlet syndrome underwent first rib resection with concomitant subclavian artery aneurysm repair. The mean follow-up duration was 38.4 ± 11.6 months. Long-term symptomatic relief was achieved in 94% of patients. Conclusions Venous thoracic outlet syndrome is the most common form of thoracic outlet syndrome in children, followed by neurogenic and arterial thoracic outlet syndromes. Competitive sports-related injuries remain the most common risk factor for venous and neurogenic thoracic outlet syndromes. Temporary arteriovenous fistula creation was useful in venous thoracic outlet syndrome patients in selective children. Surgical decompression provides durable treatment success in children with all subtypes of thoracic outlet syndrome.

Novel Surgical Approach for Decompression of the Scalene Triangle in Neurogenic Thoracic Outlet Syndrome

2018 ◽  
Vol 34 (05) ◽  
pp. 315-320 ◽  
Author(s):  
Joseph Ricci ◽  
Kyle Eberlin ◽  
Robert Hagan
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Surgical Intervention ◽  
Surgical Decompression ◽  
Outpatient Basis ◽  
Shoulder Dysfunction ◽  
Rib Resection ◽  
First Rib ◽  
Wide Range ◽  
Scalene Triangle ◽  
First Rib Resection

Thoracic outlet syndrome (TOS) is a cause of upper extremity and shoulder dysfunction. TOS can present with a wide range of symptoms due to compression of the brachial plexus or its branches during their passage through the cervicothoracobrachial region or scalene triangle. There are three types of TOS: arterial, venous, and neurogenic. Neurogenic TOS (nTOS) is by far the most frequent type and represents more than 95% of all cases. Historically, surgical intervention for all types of TOS has evolved based on the treatment for a vascular etiology and has typically included a first rib resection. Despite nTOS being by far the more common type, most previous interventions have not considered treatment via peripheral nerve decompression.We describe surgical treatment of nTOS, performed on an outpatient basis, which focuses on the surgical decompression of the structures associated with the scalene triangle in conjunction with release of the pectoralis minor insertion through limited incisions. The procedure avoids the morbidity associated with first rib resection and is successful in ameliorating nTOS symptoms. Further, we propose a nomenclature shift to scalene triangle syndrome (STS) to reflect the nerve and arterial compressions needing to be addressed.

scholarly journals Morbidity of First Rib Resection in the Surgical Repair of Thoracic Outlet Syndrome

Hand ◽  
2018 ◽  
Vol 14 (5) ◽  
pp. 636-640 ◽  
Author(s):  
Kevin T. Jubbal ◽  
Dmitry Zavlin ◽  
Joshua D. Harris ◽  
Shari R. Liberman ◽  
Anthony Echo
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Operative Time ◽  
Medical Complications ◽  
Complication Rates ◽  
Improvement Program ◽  
Cervical Rib ◽  
Rib Resection ◽  
First Rib ◽  
Increased Risk ◽  
First Rib Resection

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.

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

2021 ◽  
Vol 74 (6) ◽  
pp. 2115
Author(s):  
R. Sorber ◽  
M.L. Weaver ◽  
J.K. Canner ◽  
B. Campbell ◽  
J.H. Black ◽  
...  
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Rib Resection ◽  
First Rib ◽  
First Rib Resection

First Rib Resection for Thoracic Outlet Syndrome: The Robotic Approach

2018 ◽  
Vol 42 (10) ◽  
pp. 3250-3255 ◽  
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

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

1988 ◽  
Vol 19 (1) ◽  
pp. 131-146 ◽  
Author(s):  
Virchel E. Wood ◽  
Randy Twito ◽  
Joseph Michael Verska
Keyword(s):  
Thoracic Outlet Syndrome ◽  
Rib Resection ◽  
First Rib ◽  
First Rib Resection

Arterial Thoracic Outlet Syndrome

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

Sign in / Sign up

Export Citation Format

Share Document