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Outcomes of surgical paraclavicular thoracic outlet decompression.
[thoracic outlet syndrome]
Thoracic
outlet
syndrome
(
TOS
)
is
a
constellation
of
signs
and
symptoms
caused
by
compression
of
the
neurovascular
structures
in
the
thoracic
outlet
.
These
structures
include
the
brachial
plexus
,
the
subclavian
vein
,
and
the
subclavian
artery
,
resulting
in
neurogenic
(
NTOS
)
,
venous
(
VTOS
)
,
and
arterial
(
ATOS
)
types
of
TOS
,
respectively
.
The
purpose
of
this
study
was
to
evaluate
the
outcomes
of
paraclavicular
surgical
decompression
for
TOS
.
A
prospective
analysis
of
patients
who
underwent
surgical
decompression
for
TOS
at
a
newly
established
center
was
performed
.
Diagnosis
of
TOS
was
based
on
clinical
history
,
a
physical
examination
,
and
additional
diagnostic
studies
.
The
indication
for
surgery
in
patients
diagnosed
with
NTOS
was
the
presence
of
persistent
symptoms
after
a
trial
of
physical
therapy
.
Primary
outcomes
were
assessed
according
to
Derkash
's
classification
as
excellent
,
good
,
fair
,
and
poor
.
Secondary
outcomes
included
mortality
,
complications
,
and
duration
of
hospital
stay
.
Between
August
2004
and
June
2011
,
40
paraclavicular
decompression
procedures
were
performed
on
36
patients
(
16
men
)
with
TOS
.
The
mean
age
was
36
.
5
years
(
range
:
15
-
68
)
.
Bilateral
decompression
was
performed
on
4
patients
.
The
types
were
NTOS
(
n
=
19
;
48
%
)
,
VTOS
(
n
=
16
;
40
%
)
,
and
ATOS
(
n
=
5
;
12
%
)
.
In
addition
to
pain
,
the
most
common
presenting
symptom
was
numbness
in
NTOS
,
swelling
in
VTOS
,
and
coolness
in
ATOS
.
A
history
of
trauma
was
present
in
22
.
2
%
.
Two
patients
suffered
from
recurrent
symptoms
after
previous
transaxillary
first
rib
resection
for
VTOS
at
another
institution
.
Diagnostic
tests
performed
included
nerve
conduction
studies
(
43
%
)
,
venogram
(
40
%
)
,
and
arteriogram
(
20
%
)
.
All
patients
underwent
paraclavicular
decompression
,
which
included
radical
anterior
and
partial
middle
scalenectomy
,
brachial
plexus
neurolysis
,
and
first
rib
resection
.
The
first
rib
resection
was
partial
,
through
a
supraclavicular
only
approach
in
NTOS
and
ATOS
patients
(
60
%
)
or
complete
,
through
a
supra-
and
infraclavicular
approach
for
VTOS
patients
(
40
%
)
.
Functional
outcomes
were
excellent
,
good
,
fair
,
and
poor
in
74
.
4
%
,
15
.
4
%
,
10
.
3
%
,
and
0
%
of
cases
,
respectively
.
One
patient
was
lost
to
follow-up
.
Two
patients
with
incomplete
relief
of
symptoms
after
paraclavicular
decompression
for
NTOS
underwent
pectoralis
minor
decompression
.
There
were
no
deaths
.
Complications
included
pleural
effusion
requiring
evacuation
(
n
=
4
)
,
neuropraxia
(
n
=
1
)
,
and
lymph
leak
(
n
=
1
)
treated
with
tube
thoracostomy
.
No
patients
experienced
injury
to
the
long
thoracic
or
phrenic
nerves
.
The
mean
duration
of
hospital
stay
was
4
.
4
days
.
The
mean
follow-up
was
10
.
3
months
.
In
our
experience
,
surgical
paraclavicular
decompression
can
provide
safe
and
effective
relief
of
NTOS
,
VTOS
,
and
ATOS
symptoms
.
Functional
outcomes
were
excellent
or
good
in
the
majority
of
patients
,
with
minimal
complications
.
Diseases
Validation
Diseases presenting
"rib resection"
symptom
dedifferentiated liposarcoma
thoracic outlet syndrome
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