Thoracic Outlet Syndrome: Follow-up on 33 Cases with Regard to Vascular Compression

This follow-up study on 33 operations performed for thoracic outlet syndrome (TOS) proves high efficiency in relieving neurological and arterial symptoms, whereas benefit to venous compression is somewhat less. Twenty-six patients (average age was 36 years) were operated on for TOS, seven of them on both sides. There was a higher incidence in females. All patients showed neurological symptoms. In 15, operations on various entrapment syndromes of the upper extremity were performed previously. Six patients presented with an incomplete resection of the first rib. Arterial compression symptoms were evident in 15 cases, symptoms of venous compression in 14 limbs. All patients underwent a resection of the first rib, bilateral in seven cases, using the axillary and supraclavicular approach. In seven patients, a cervical rib and scalenus muscles were resected additionally, in three patients bilaterally. In two cases a neurolysis of the brachial plexus was performed. Using the supraclavicular approach, no complications occurred. In one early patient using the transaxillary approach to a postoperative hemothorax required a revision. Neurological results after surgery showed a total release in 26 limbs (n = 33). In 14 limbs (n = 15) with arterial compression symptoms and in 6 (n = 14) with symptoms of venous compression the operation showed a curative effect.