Arjun Jayaraj1, Audra A Duncan2, Manju Kalra2, Thomas C Bower2, Peter Gloviczki2. 1. Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN. Electronic address: jayaraj.arjun2015@gmail.com. 2. Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
Abstract
BACKGROUND: Cervical rib can often be symptomatic causing neurogenic thoracic outlet syndrome (nTOS). Surgical treatment involves rib resection through a supraclavicular, transaxillary or combined approach. We review outcomes of different approaches and describe our technique of transaxillary resection through a video. METHODS: A single-center retrospective review of perioperative and short-term outcomes in subjects undergoing cervical rib resection for nTOS between 1994 and 2013 was performed. RESULTS: Of the 75 operations performed for nTOS, 40% (30 procedures in 29 patients) required resection of cervical ribs. The first and cervical ribs were removed in 24 operations, whereas only the cervical rib was resected in 6. Scalenectomy was performed in all patients. Thirteen (43%) procedures were performed with a supraclavicular-only (SC group) approach, 9 (30%) with a transaxillary-only (TA group) approach, and 8 (27%) with a combined approach (TA + SC group). Incidence of persistent nTOS symptoms occurred in 3 (23%) of SC patients, 1 (13%) TA patient, and 2 (25%) TA + SC patients (P > 0.05). Recurrence of symptoms was noted in one patient (8%) in the SC group at 1-year follow-up. No patient required operative reintervention. CONCLUSIONS: Resection of cervical ribs and/or first ribs in the treatment of nTOS can be safely performed through SC, TA, or a combined approach. In young patients, a TA incision should be considered to avoid a neck incision, with outcomes similar to alternate approaches.
BACKGROUND: Cervical rib can often be symptomatic causing neurogenic thoracic outlet syndrome (nTOS). Surgical treatment involves rib resection through a supraclavicular, transaxillary or combined approach. We review outcomes of different approaches and describe our technique of transaxillary resection through a video. METHODS: A single-center retrospective review of perioperative and short-term outcomes in subjects undergoing cervical rib resection for nTOS between 1994 and 2013 was performed. RESULTS: Of the 75 operations performed for nTOS, 40% (30 procedures in 29 patients) required resection of cervical ribs. The first and cervical ribs were removed in 24 operations, whereas only the cervical rib was resected in 6. Scalenectomy was performed in all patients. Thirteen (43%) procedures were performed with a supraclavicular-only (SC group) approach, 9 (30%) with a transaxillary-only (TA group) approach, and 8 (27%) with a combined approach (TA + SC group). Incidence of persistent nTOS symptoms occurred in 3 (23%) of SC patients, 1 (13%) TA patient, and 2 (25%) TA + SC patients (P > 0.05). Recurrence of symptoms was noted in one patient (8%) in the SC group at 1-year follow-up. No patient required operative reintervention. CONCLUSIONS: Resection of cervical ribs and/or first ribs in the treatment of nTOS can be safely performed through SC, TA, or a combined approach. In young patients, a TA incision should be considered to avoid a neck incision, with outcomes similar to alternate approaches.
Authors: Andreas Gkikas; Savvas Lampridis; Davide Patrini; Peter B Kestenholz; Luis Filipe Azenha; Gregor Jan Kocher; Marco Scarci; Fabrizio Minervini Journal: Front Surg Date: 2022-03-08