https://www.jvascsurg.org/article/0741-5214(89)90005-0/pdf

The treatment of thoracic outlet syndrome: A comparison of different operations

Venous thoracic outlet syndrome is a complex but rare disease that often can have excellent outcomes if quickly recognized and treated. The syndrome results from compression of the subclavian vein along its exit from the thoracic cavity and frequently affects young otherwise healthy patients. Modern diagnosis is made with a combination of clinical exam, appropriate non-invasive imaging, and, finally, contrast venography, which can be both diagnostic and therapeutic. Treatments have evolved over time to the point where patients can undergo less extensive procedures than previously performed and still maintain excellent outcomes. One of the most important predictors of outcome is the initiation of treatment within 14 days of symptoms. Hence, the importance of the accurate and prompt diagnosis of this syndrome in patients with an upper-extremity deep vein thrombotic episode cannot be further underscored. This review is a concise summary of the background and treatment algorithm for this patient population.

https://journals.sagepub.com/doi/pdf/10.1177/1358863X14568704

Venous thoracic outlet syndrome

Long-term outcome after transaxillary approach for thoracic outlet syndrome

Thoracic Outlet Syndrome: A review.

✓ The application of an old surgical technique, previously employed for treatment of thoracic outlet syndromes, to lesions of the brachial plexus is discussed. Positioning of the patient, the surgical procedure, and selected indications for a posterior subscapular approach with resection of the first rib are discussed. The indications for the use of this approach are: proximal plexus lesions involving roots and/or trunks believed to be repairable, complicated thoracic outlet syndromes, prior anterior exploration for vascular or nervous structure disease, and progressive plexus palsy associated with damage to the soft tissue of the anterior chest wall and supraclavicular regions secondary to irradiation. The authors' experience to date with 12 such cases is presented in chart form, while five cases are presented in some detail.

Exploration of selected brachial plexus lesions by the posterior subscapular approach

T HE costoclavicular syndrome appears to have been described first by Bramwell 2 in 1903. In 19 l0 Thomas Murphy 4 reported symptomatic relief in this condition following division of the first thoracic rib. Since then, a large body of literature has grown on the subject, and this was well summarized in Naffziger and Grant's paper of 1938. 5 The surgical relief of the syndrome has largely conformed to Adson's original technique 1 intended for removal of the cervical rib, although other techniques have been described, namely, the posterior approach recommended by Clagett ~ and the axillary approach by Roos. 6 It should be noted that Adson's technique 1 was intended for a largely supraclavicular structure, and its widespread acceptance as a technique for removing the first thoracic rib is surprising, considering that more than 50% of this rib lies deep to, or below, the clavicle. This supraclavicular approach leads to a lengthy and laborious dissection with displacement of axillary and subclavian vessels and the trunks of the plexus, as well as sectioning of the branches of the thoracocervical trunk, and careful retraction of the lymphatic duct. These steps are both time-consuming and hazardous. The posterior approach advocated by ClageW also has its difficulties. An incision has to traverse a considerable depth of vascular muscle tissue to reach the goal on the anterior surface of the body. Although the transaxillary approach described by Roos 6 is more attractive than the two approaches described above, the goal of the dissection again lies deep to the incision at the apex of a coneshaped dissection. The simplest approach in our experience has been through an anterior infraclavicular incision. Here, the first thoracic rib lies close to the surface and is easily identified; the anterior third lies well below the clavicle and is easily accessible. The neurovascular bundle

Relief of costoclavicular syndrome by infraclavicular removal of first rib. Technical note.

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Relief of costoclavicular syndrome by infraclavicular removal of first rib. Technical note.