Transaxillary or supraclavicular decompression for the thoracic outlet syndrome. A comparison of the risks and benefits.

The difficult exposure with the transaxillary resection of the first rib (TAR) prompted an analysis of the TAR versus the supraclavicular approach (SCR) for decompressing the thoracic outlet in patients with thoracic outlet syndrome (TOS). Thirty-seven patients underwent 30 TAR and 15 underwent SCR for TOS. The operating time was similar for the two groups. Mean blood loss was 61 cc for the SCR group and 218 cc for the TAR group. There was one complication in the SCR group, a urinary tract infection, whereas the TAR group had 21 complications including pneumothorax (13), laceration of subclavian vessel (3), winged scapula (3), pleural effusion (1), and wound infection (1). Postoperative hospitalization averaged 3 and 5 days, respectively, for the SCR and TAR patients. All SCR patients and all but one TAR patient were improved or asymptomatic immediately postoperatively. Ninety-three per cent and 81 per cent, respectively, of SCR and TAR patients were improved at 2 months, whereas 100 per cent and 83 per cent, respectively, remained improved at a mean follow-up of 3 years. The significantly fewer complications, decreased blood loss and shorter postoperative hospitalization, noted in the SCR patients supports this approach as the preferred form of management for TOS.