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Italian Journal of Vascular and Endovascular Surgery 2006 June;13(2):95-100

Copyright © 2006 EDIZIONI MINERVA MEDICA

language: English

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


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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.

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