A Retrospective study on Thoracic Outlet Syndrome

BACKGROUND: Thoracic Outlet Syndrome (TOS) refers to clinical problems that develop as a result of neurovascular compression in the unique anatomic region in the neck dominated by the anterior and middle scalene muscles, the first rib, and their associated structures. METHODS: Our experience with consecutive operations for TOS, over a period of 12 years from 1995 to 2007, has been reviewed retrospectively. Preoperative symptoms and signs, investigations, surgery done, complications and the outcome of surgery are analysed. RESULTS: A total of 56 patients underwent 60 operations for decompression of TOS. Forty eight patients had decompression by the transaxillary approach. In 12 patients, a supraclavicular approach was used. There was no operative mortality in this series. The operative complications included pneumothorax in 4 patients, vascular injury in 1 patient. The mean duration of postoperative hospital stay was 6.6 days. CONCLUSION: The results of the present study shows presence of cervical rib to be the cause of thoracic outlet syndrome, which could mean reluctance in the diagnosis of the same in the absence of a cervical rib in our set up. The presence of complete cervical rib in all patients with vascular pathology might mean a need for systematic evaluation of vascular pathology in patients with complete rib. It also confirms that transaxillary excision of the first rib is a surgical procedure associated with very low morbidity. It can be offered as an early option for patients with thoracic outlet syndrome. Supraclavicular approach is recommended if exposure of the subclavian artery is required for vascular reconstruction