Thirty-year experience of transaxillary resection of first rib for thoracic outlet syndrome

Background: The clinical outcomes of reoperations for recurrent neurogenic thoracic outlet syndrome (NTOS) remain undefined. Methods: From 2009 to 2019, 90 patients with recurrent NTOS underwent anatomically complete supraclavicular reoperation after previous operation(s) performed at other institutions using either supraclavicular (Prev-SC = 48), transaxillary (Prev-TA = 31), or multiple/combination (Prev-MC = 11) approaches. Prospectively maintained data were analyzed retrospectively. Results: The mean patient age was 39.9 ± 1.4 years, 72% were female, and the mean interval after previous operation was 4.1 ± 0.6 years. The mean Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score was 62 ± 2, reflecting substantial preoperative disability. Residual scalene muscle was present in 100% Prev-TA, 79% Prev-SC, and 55% Prev-MC ( P < .05). Retained/residual first rib was present in 90% Prev-TA, 75% Prev-SC, and 55% Prev-MC ( P < .05). There were no differences in operative time (overall 210 ± 5 minutes), length of hospital stay (4.7 ± 0.2 days), or 30-day readmissions (7%). During follow-up of 5.6 ± 0.3 years, the improvement in QuickDASH scores was 21 ± 2 (36% ± 3%) ( P < .01) and patient-rated outcomes were excellent in 10%, good in 36%, fair in 43%, and poor in 11%. Conclusions: Anatomically complete decompression for recurrent NTOS can be safely and effectively accomplished by supraclavicular reoperation, regardless of the type of previous operation. Residual scalene muscle and retained/residual first rib are more frequently encountered after transaxillary operations than after supraclavicular or multiple/combined operations. Supraclavicular reoperation can achieve significant symptom reduction and functional improvement for approximately 90% of patients with recurrent NTOS.

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Excision of First Rib for Thoracic Outlet Syndrome

Thoracic Surgical Techniques ◽

10.1007/978-3-319-66270-1_17 ◽

2018 ◽

pp. 69-72

Author(s):

Francis C. Wells ◽

Aman S. Coonar

Keyword(s):

Thoracic Outlet Syndrome ◽

First Rib

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T1 Paravertebral Catheter for Postoperative Pain Management After First Rib Resection for Venous Thoracic Outlet Syndrome

A & A Practice ◽

10.1213/xaa.0000000000000698 ◽

2018 ◽

Vol 11 (1) ◽

pp. 1-3

Author(s):

Arun Kalava ◽

Abby M. Pribish

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Thoracic Outlet Syndrome ◽

Postoperative Pain Management ◽

Rib Resection ◽

First Rib ◽

First Rib Resection

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

Hand ◽

10.1177/1558944718760037 ◽

2018 ◽

Vol 14 (5) ◽

pp. 636-640 ◽

Cited By ~ 2

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.

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