Thoracic Outlet Syndrome: A Surgical Case Series

Allan S. Brett, MD reviewing Orlando MS et al. J Am Coll Surg 2015 May.

Among 538 cases, 52% were neurogenic, and 44% were venous.

Thoracic outlet syndrome (TOS) is classified as neurogenic, venous, or arterial, depending on whether the brachial plexus nerves, subclavian vein, or subclavian artery is compressed. In this retrospective study from a referral practice, Johns Hopkins surgeons describe their experience with 538 consecutive patients who underwent first rib resection for TOS between 2003 and 2013.

Most cases were neurogenic (52%) or venous (44%); only 4% were arterial. Mean age was in the 30s for all three groups. Women were 78%, 55%, and 64% of the three groups, respectively. Surgery was performed for patients with neurogenic TOS who did not respond to 8 weeks of physical therapy; for vascular TOS, surgery was performed when patients presented with thrombosis or embolism, compression or occlusion, or aneurysm. The authors state that 95% of patients had “positive outcomes” (improved symptoms for neurogenic cases, and vessel patency for vascular cases).

Citation(s):

Orlando MS et al. A decade of excellent outcomes after surgical intervention in 538 patients with thoracic outlet syndrome. J Am Coll Surg 2015 May; 220:934.