Trans-axillary approach in surgery for thoracic outlet syndrome

Yıl 2016, Cilt: 2 Sayı: 2, 112 - 115, 04.07.2016

Serhat Yalcinkaya , Cuneyt Eris , Tugrul Goncu

https://doi.org/10.18621/eurj.2016.5000159923

Öz

Background. Thoracic outlet syndrome may be due to various reasons and be classified as neurogenic, arterial, and venous thoracic outlet syndrome. The surgical treatment of neurogenic thoracic outlet syndrome can be performed using either a trans-axillary or a supraclavicular approach. The aim of this study is to report on such patients operated in a single institution by a single thoracic surgeon using trans-axillary approach. Methods. The patient files were screened for patients operated due to neurogenic thoracic outlet syndrome related symptoms between September 1, 2002 and April 1, 2015 in the Department of Thoracic Surgery of Bursa Yuksek Ihtisas Training and Research Hospital. Results. There were 22 female and five male patients with an average age of 31.9±11.7 years. The most common symptom was pain in the affected limb and shoulder (n=29). Of the diagnostic maneuvers abduction external rotation (Roos) test was the most frequently found positive test (n=27). Nerve conduction velocity studies revealed an average ulnar nerve conduction velocity of 62.7±6.6 m/s. Limited pneumothorax uneventfully resolved in 2 days was seen following 12 operations. Conclusion. We conclude that trans-axillary approach may provide good exposure with favorable opportunity to excise the 1^st and the cervical rib, and neurolysis with a low rate of complication.

Anahtar Kelimeler

Thoracic outlet syndrome, surgery, trans-axillary approach

Kaynakça

• Ciampi P, Scotti C, Gerevini S, DeCobelli F, Chiesa R, Fraschini G, et al. Surgical treatment of thoracic outlet syndrome in young adults: single centre experience with minimum three-year follow-up. Int Orthop 2011;35:1179-1186.
• Thompson RW. Challenges in the treatment of thoracic outlet syndrome. Tex Heart Inst J 2012;39:842-843.
• Lattoo MR, Dar AM, Wani ML, Bhat MA, Ahangar AG, Lone GN, et al. Outcome of trans-axillary approach for surgical decompression of thoracic outlet: a retrospective study in a tertiary care hospital. Oman Med J 2014;29:214-216.
• Al-Hashel JY, El Shorbgy AA, Ahmed SF, Elshereef RR. Early versus late surgical treatment for neurogenic thoracic outlet syndrome. ISRN Neurol 2013;2013:673020.
• Tokat AO, Akal M. [Surgical treatment routes of thoracic outlet syndrome]. Turkiye Klinikleri J Med Sci 2003;23:89-93. [Article in Turkish]
• Cubuk S, Yucel O. [Long term results of thoracic outlet syndrome surgery]. Toraks Cerrahisi Bulteni 2014;5:132-135. [Article in Turkish]
• Chang KZ, Likes K, Davis K, Demos J, Freischlag JA. The significance of cervical ribs in thoracic outlet syndrome. J Vasc Surg 2013;57:771-775.
• Han S, Yildirim E, Dural K, Ozisik K, Yazkan R, Sakinci U. Transaxillary approach in thoracic outlet syndrome: the importance of resection of the first-rib. Eur J Cardiothorac Surg 2003;24:428-433.
• Rochlin DH, Gilson MM, Likes KC, Graf E, Ford N, Christo PJ, Freischlag JA. Quality-of-life scores in neurogenic thoracic outlet syndrome patients undergoing first rib resection and scalenectomy. J Vasc Surg 2013;57:436-443.
• Kaplan T, Han S. [Transaxillary approach in surgery for thoracic outlet syndrome]. Toraks Cerrahisi Bulteni 2014;5:112-114. [Article in Turkish]
• Balci AE, Cakir O, Eren MN, Eren S, Bayar E. [Is resection of first rib necessary in thoracic outlet syndrome caused from cervical rib?] Turk Gogus Kalp Dama 2001;9:156-159. [Article in Turkish]
• Cordobes-Gual J, Lozano-Vilardell P, Torreguitart-Mirada N, Lara-Hernandez R, Riera-Vazquez R, Julia-Montoya J. Prospective study of the functional recovery after surgery for thoracic outlet syndrome. Eur J Vasc Endovasc Surg 2008;35:79-83.