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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Italian Journal of Vascular and Endovascular Surgery 2006 June;13(2):95-100
Thoracic outlet syndrome in adults and children: an up-to-date about treatment strategies over the last 5 years’ experience
Vercellio G., Baraldini V., Cigognetti F., Coletti M., Cipolat L.
Vascular Surgery Unit V. Buzzi Children's Hospital, Milan, Italy
Aim. Aim of the study was to review the different therapeutic strategies employed and the results obtained during the last 5 years in the treatment of thoracic outlet syndrome (TOS).
Methods. From February 1999 to February 2004, 57 operations for decompression in TOS were performed by a single surgeon on 50 patients (37 females, 13 males) ranging in age between 8 and 61 years. Eleven patients (22%) were in pediatric age (under 18 years). The decompression was achieved through different surgical techniques (first rib resection ± resection of cervical rib/transverse mega-apophysis; pectoralis minus tendon resection) and different surgical accesses (supraclavicular: 23 cases; axillary: 26; combined supra-subclavicular iuxtaclavicular: 7 and subclavicular: 1 case) following an operative flow-chart based on the main symptoms referred by the patient (neurological, venous or arterial) and the presence/absence of skeletal anomalies (cervical rib or transverse mega-apophysis) which were observed in 40% of cases.
Results. Four significant complications were observed in this series (1 pleural fluid collection, 2 lymphocele and 1 chylocele). A thoracic drain was positioned at the end of the operation in 7 patients (12.3%) who had pleural lesions. Postoperative hospital stay ranged between 1 and 12 days (mean 3.5 days). Complete symptoms relief was obtained in 52 procedures (91.2%) at a mean follow-up of 37 months (6-60 months). Two patients underwent a second operation for relapse.
Conclusions. Surgical decompression for TOS through different accesses on the basis of the operative flow-chart exposed is feasible with excellent results, short postoperative hospital stay and very low morbidity rate also in pediatric age.