A DECADE OF EXCELLENT OUTCOMES AFTER SURGICAL INTERVENTION: 538 PATIENTS WITH THORACIC OUTLET SYNDROME.

This review describes the outcomes for patients who underwent first rib resection for all three forms of thoracic outlet syndrome during a period of 10 years. The data were previously published in 2014 and the ACCA presentation, and this manuscript are derived largely from this work (1). Patients treated with first rib section from August 2003 through July 2013 were retrospectively reviewed using a prospectively maintained database. Five hundred thirty-eight patients underwent 594 first rib resections for indications of neurogenic (n = 308, 52%), venous (n = 261, 44%), and arterial (n = 25, 4%). Fifty-six (9.4%) patients had bilateral first rib resection surgery. Fifty-two (8.8%) patients had cervical ribs. Three hundred ninety-eight (67%) of the first rib resections were performed on female patients with a mean age of 33 years (range, 10 to 71 years). Three hundred forty (57%) were right-sided procedures. Seventy-five children (aged 18 years or younger) underwent first resection - 25 during the first 5 years, and 50 during the second 5 years. When comparing the second 5-year period with the first 5-year period, more patients had venous thoracic outlet syndrome (48% vs. 37%; P < 0.02). Fewer patients had neurogenic thoracic outlet syndrome (48% vs. 58%; P < 0.05) and improved or fully resolved symptoms increased from 93% to 96%. Complications included 2 vein injuries, 2 hemothoraces, 4 hematomas, 138 pneumothoraces (23%), and 8 (1.3%) wound infections. Length of hospital stay was 1 day. Excellent results were seen in this surgical series of neurogenic, venous, and arterial thoracic outlet syndrome due to appropriate selection of neurogenic patients, use of a standard protocol for venous patients, and expedient intervention in arterial patients. There is an increasing role for surgical intervention and children.