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Complications of surgery for thoracic outlet syndrome
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
There remains some room for debate regarding the necessity for first rib resection during supraclavicular thoracic outlet decompression, with some advocating for routine first rib resection and others for a more selective approach based on intraoperative findings following scalenectomy and brachial plexus neurolysis alone.40 However, it remains unclear if there are any advantages to retaining the first rib, and incomplete first rib resection is often a factor contributing to recurrent neurogenic TOS.34–39 It is therefore recommended that first rib resection always be included in supraclavicular decompression for neurogenic TOS, extending posteriorly as far as the level of the T1 nerve root and anteriorly to the costochondral junction (just medial to the scalene tubercle) (Figure 28.5). The first rib is often abnormal in patients with a cervical rib, and may serve as a source of persistent/recurrent nerve compression after isolated cervical rib resection. Thus, first rib resection is also advocated in patients with cervical ribs, along with resection of the cervical rib, in order to ensure the most complete decompression feasible.41
Thoracic outlet syndromes
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Hugh A. Gelabert, Erdogan Atasoy
The surgical approaches to first rib resection then fol- lowed. O. T. Clagett in 1962 described the use of posterior high thoracoplasty for first rib resection.3 David. B. Roos published the initial description of transaxillary first rib resection in 1966,4 and Robert. J. Sanders described the supraclavicular resection of a first rib in 1985.5
Unilateral diaphragmatic dysfunction following thoracic outlet surgery diagnosed by point-of-care ultrasound
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Wesley Cain, Sunny S. Cai, Christian Salcedo, Steven Embry, Melissa Scalise
A 45-year-old female with history of Protein C deficiency and recent right thoracic outlet decompression surgery and first right first rib resection 3 weeks prior presented to an internal medicine clinic with dyspnea on exertion of one day duration. The patient was in good health up until 8 months before presentation when she developed recurrent transient ichemic attacks (TIAs). She underwent extensive evaluation at several hospitals and eventually was found to have thoracic outlet syndrome of the left upper extremity and possible thrombus at the subclavian artery. She successfully underwent left-sided thoracic outlet decompression and left first rib resection 7 months prior to presentation. Her post-op period was complicated by a subocclusive left external iliac deep vein thrombosis (DVT), and she was treated with apixaban. She recovered over the next several months and continued anticoagulation for her prior TIAsand DVT in the setting of Protein C deficiency. Two months prior to presentation, she developed right arm symptoms consistent with thoracic artery outlet syndrome on the contralateral side. She ultimately underwent thoracic outlet decompression surgery and right first rib resection 3 weeks prior to presentation, only missing full anticoagulation for 2 days. She was recovering as expected until she began to notice dyspnea on exertion 1 day prior to presentation.
Familial predisposition of thoracic outlet syndrome: does a familial syndrome exist? Report of cases and review of literature
Published in Acta Chirurgica Belgica, 2021
Jens Goeteyn, Niels Pesser, Bart van Nuenen, Marc van Sambeek, Joep Teijink
These cases show a familial predisposition of thoracic outlet syndrome. A review of literature (Medline, EMBASE) could only identify two earlier case reports of familial predisposition of thoracic outlet syndrome [7,8]. One article reports on three patients in the same family (mother, daughter and aunt) diagnosed and treated for VTOS. They were all treated with a trans-axillary first rib resection with good results [8]. There is no description of possible anatomical variations of mechanism that caused three patients of the same family to end up with VTOS. Another case report describes the presence of CRs (described as apophysomegaly of the seventh cervical vertebra) in 13 family members of the same household (mother and 12 out of 13 children). All patients received physiotherapy and pain relief. Three children were additionally treated with TOD with resection of the CR [7].
Effects of radiation and MediPort placement on the development of thoracic outlet syndrome
Published in Baylor University Medical Center Proceedings, 2020
Clara Grimsley, Robert Corn, Stephen Hohmann, John Eidt, Bertram Smith, Gregory Pearl, Bradley R. Grimsley
A venogram of the right subclavian vein disclosed chronic, complete occlusion (Figure 1a). Angioplasty showed significant waisting of the balloon at the costoclavicular junction indicating external compression consistent with venous TOS. The final result was a 20% diameter stenosis of the right subclavian vein. A right transaxillary first rib resection was performed in May 2018. There was evidence of radiation-induced fibrosis of the subcutaneous tissues. A right upper-extremity venogram demonstrated complete occlusion of the right subclavian and innominate vein (Figure 1b). After traversing the lesion, serial dilation was performed, which led to a residual stenosis of 4 mm in maximum diameter. An 8-mm cutting balloon was then used at the residual stenosis, and a venogram showed a focal dissection vs extravasation of the subclavian vein. We performed stent-assisted angioplasty with an 11 × 59 mm VBX stent (balloon expandable, covered stent) and then a subsequent 11 × 39 VBX stent. VBX stents were placed because the thoracic outlet was decompressed and the proximal and distal landing zones were large in diameter. We had an excellent angiographic result (Figure 1c, 1d). The patient recovered well and was discharged home on the second postoperative day on aspirin, clopidogrel, and dabigatran.