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Italian Journal of Vascular and Endovascular Surgery 2019 March;26(1):6-9

DOI: 10.23736/S1824-4777.18.01394-3


language: English

Transaxillary decompression of thoracic outlet syndrome

Francesco STILO 1, Nunzio MONTELIONE 1, 2 , Rossella C. VIGLIOTTI 1, 3, Francesco SPINELLI 2

1 Division of Vascular Surgery, University of Campus Bio-Medico, Rome, Italy; 2 Division of Vascular and Endovascular Surgery, Department of Surgery “Paride Stefanini”, Umberto I Polyclinic, Sapienza University, Rome, Italy; 3 Division of Vascular Surgery, Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Sassari, Italy

BACKGROUND: The thoracic outlet syndrome (TOS) is a defined clinical and etiologically disorder characterized by the compression of the neurovascular bundle in the thoracic outlet with an estimated incidence of 0.3% to 2% in the general population. The most frequent is the neurogenic TOS, while the arterial and the venous TOSs are relatively uncommon. The diagnosis is essentially clinic, supported by imaging. The aim of this study was to present our experience in surgical decompression of TOS through transaxillary approach.
METHODS: A retrospective study was conducted on a prospectively compiled, computerized database between May 2014 and June 2018 including patients affected by TOS surgically treated in our center. We obtained diagnosis firstly considering clinical presentation and physical examination; then performing chest radiography, computed tomography angiography and/or magnetic resonance imaging, which can exclude other cause for patient’s symptoms.
RESULTS: Of the 16 patients, 14 were women (87.5%) and 2 were man (12.5%). Median age was 37.4±10.6. Clinical presentation was neurological in 10 patients (62.5%), venous in 3 (18.7%) and arterial in 1 patient (6.25%). In two patients (12.5%) both neurological and venous symptoms were present. Two patients (12.5%) had bilateral TOS. Technical success was achieved in all cases. The main perioperative complication was pneumothorax in 8 patients (50%). Neurological complications or nerve injury were null. Symptoms recurrence was 6.25%.
CONCLUSIONS: In our experience transaxillary approach is a safe and feasible procedure associated with an acceptable rate of peri-operative morbidity and satisfactory long-term relief of symptoms.

KEY WORDS: Thoracic outlet syndrome - Cervical rib - Decompression, surgical

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