Successful Return to Active Duty after First Rib Resection for Thoracic Outlet Syndrome.
Ann Vasc Surg
; 62: 268-274, 2020 Jan.
Article
en En
| MEDLINE
| ID: mdl-31449939
ABSTRACT
BACKGROUND:
The optimal surgical approach and treatment algorithm for thoracic outlet syndrome (TOS) remain controversial. We sought to examine the outcomes of patients treated at a military medical treatment facility (MTF) for TOS.METHODS:
A retrospective review was performed on all patients who had a first rib resection (FRR) for TOS over a 9-year period at a single MTF. Patient demographics, perioperative details, and patient outcomes were examined. Active duty (AD) status and return to AD were reviewed.RESULTS:
From 2008 to 2016, 33 FRRs were performed in 32 patients. Of these, 30 patients were on AD with a mean age of 27 years (range, 19-44). The 29 male and 4 female patients were treated for symptoms of venous (23), neurogenic (6), or arterial (4) TOS. The mean time from onset of symptoms was 11 months (range, 1 to 120). The FRR was performed via a transaxillary (13), supraclavicular (12), or paraclavicular (8) approach. Of 21 AD patients with venous TOS, 16 (76%) underwent preoperative thrombolysis. A postoperative venogram or ultrasound was performed in 20 patients, documenting vein patency in 18 (90%). Nine patients underwent subsequent venoplasty or stent placement. Most patients (15) were placed on anticoagulation for 1-6 months. Two AD patients had perioperative complications including a lymph leak and brachial plexus palsy. Twenty-four (89%) patients returned to AD status. One recruit never returned to AD after successful FRR, and two other patients did not return for medical reasons unrelated to the FRR.CONCLUSIONS:
Despite a variety of surgical approaches and often delayed presentation, we identified a high percentage of postoperative vein patency and return to AD status in our population. The debate over surgical approach remains; however, a multimodal approach individualized to the patient's presentation and meticulous surgical technique led to successful outcomes in our healthy military population.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Osteotomía
/
Costillas
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Síndrome del Desfiladero Torácico
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Descompresión Quirúrgica
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Reinserción al Trabajo
/
Personal Militar
Tipo de estudio:
Observational_studies
/
Prognostic_studies
Límite:
Adult
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Female
/
Humans
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Male
/
Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Ann Vasc Surg
Asunto de la revista:
ANGIOLOGIA
Año:
2020
Tipo del documento:
Article
País de afiliación:
Canadá