Thoracic outlet syndrome: Pattern of clinical
success after operative decompression Available online
9 July 2005.
Presented at the Nineteenth Annual Meeting of the Midwestern
Vascular Society, Victoria, British Columbia, Canada,
Sep 11–14, 2004.
Grant G. Altobelli, Toshifumi Kudo MD, PhD, Bradley T.
Haas, Fiona A. Chandra, Jennifer L. Moy BS and Samuel
S. Ahn MD ,
To evaluate the pattern of clinical results in patients
with neurogenic thoracic outlet syndrome (N-TOS) after operative
decompression and longitudinal follow-up.
From May 1994 to December 2002, 254 operative sides in 185
patients with N-TOS were treated by the same operative protocol:
(1) transaxillary first rib resection and the lower part
of scalenectomy for the primary procedure with or without
(2) the subsequent upper part of scalenectomy with supraclavicular
approach for patients with persistent or recurrent symptoms.
This retrospective cohort study included 38 men and 147
women with an age range of 19 to 80 years (mean, 40 years).
Evaluated were primary success, defined as uninterrupted
success with no procedure performed, and secondary success,
defined as success maintained by the secondary operation
after the primary failure. Success was defined as =50% symptomatic
improvement judged by the patient using a 10-point scale,
returning to preoperational work status, or both.
Follow-up was 2 to 76 months (mean, 25 months). Eighty sides
underwent a secondary operation for the primary clinical
failure. No technical failures and no deaths occurred =30
days after the operations. The complication rate was 4%
(13/334) and consisted of 7 pneumothoraxes, 3 subclavian
vein injuries, 1 nerve injury, 1 internal mammary artery
injury, and 1 suture granuloma. Of 254 operative sides,
the primary and secondary success was 46% (118/254) and
64% (163/254). Most the primary failures (90%, 122/136)
and the secondary failures (66%, 23/35) occurred =18 months
after the respective operation.
The long-term results of operations for TOS in this study
were much worse than those initially achieved, and most
of the primary and secondary failures occurred =12 months
of the respective operations. A minimum of 18-month follow-up
on patients and standardized definition of the outcomes
are necessary to determine the true effectiveness and outcome
of operative treatment of N-TOS.