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Ann Vasc Surg ; 28(3): 742.e5-8, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24485068


This article reports on 3 patients who presented with arterial thoracic outlet syndrome and were found to have a rare clinical entity. All 3 patients presented with a rare cervical rib, which was also found to be fused to the second rib, with no first rib at all. All underwent transaxillary cervical and second rib resections and anterior scalenectomy. After transaxillary thoracic outlet decompression, all completed physical therapy with complete resolution of symptoms.

Costela Cervical/anormalidades , Síndrome do Desfiladeiro Torácico/etiologia , Adolescente , Adulto , Costela Cervical/diagnóstico por imagem , Costela Cervical/cirurgia , Descompressão Cirúrgica/métodos , Feminino , Humanos , Masculino , Osteotomia , Modalidades de Fisioterapia , Radiografia , Síndrome do Desfiladeiro Torácico/diagnóstico , Síndrome do Desfiladeiro Torácico/cirurgia , Resultado do Tratamento , Adulto Jovem
J Vasc Surg ; 57(2): 436-43, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23182158


OBJECTIVE: First rib resection and scalenectomy (FRRS) has been shown to improve short-term quality of life (QOL) in the treatment of neurogenic thoracic outlet syndrome (NTOS). Long-term benefits are not well studied but are believed to decrease over time. Our objective was to evaluate long-term NTOS outcomes using validated QOL instruments. METHODS: We identified 162 NTOS patients aged ≥18 years treated by FRRS from 2003 to 2010 after they had not responded to conservative management. The patients were mailed three surveys to assess QOL (Short-Form 12 [SF-12], Brief Pain Inventory [BPI], and Cervical Brachial Symptom Questionnaire [CBSQ]), with five total outcomes measures including the SF-12 Physical Component Score (PCS), SF-12 Mental Component Score (MCS), BPI severity, BPI interference, and CBSQ score. Demographic and clinical data were extracted from patient records. Each FRRS was categorized based on postoperative clinical assessment as successful, failed, or leading to recurrent symptoms. RESULTS: Survey yield was 53.7% (n = 87) with mean follow-up of 44.7 months (range, 12.4-91.9 months). There was no significant difference in QOL scores associated with long-term compared with short-term follow-up. Significantly poorer scores on all instruments were associated with comorbid chronic pain syndromes, opioid use, and unfavorable clinical assessment (P < .05). Significantly poorer scores on select instruments were associated with smoking (BPI both; P < .02), age ≥40 years (SF-12 PCS, BPI interference, CBSQ; P < .03), neck and/or shoulder disease (SF-12 both, BPI both; P < .01), postoperative injections (BPI both, CBSQ; P < .05), and complications (SF-12 PCS, CBSQ; P < .05). A positive preoperative scalene block was not significantly associated with long-term QOL scores. CONCLUSIONS: The QOL after FRRS shows no significant difference with longer follow-up. Clinical assessment reflects patient-reported outcomes and can gauge postoperative improvement. Patient factors, particularly comorbidities and opioid use, are more predictive of long-term QOL than is preoperative scalene block and should also be considered when selecting patients for surgical intervention.

Descompressão Cirúrgica/métodos , Osteotomia , Qualidade de Vida , Costelas/cirurgia , Síndrome do Desfiladeiro Torácico/cirurgia , Adulto , Analgésicos Opioides/uso terapêutico , Baltimore , Distribuição de Qui-Quadrado , Comorbidade , Estudos Transversais , Técnicas de Apoio para a Decisão , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/psicologia , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Modelos Lineares , Masculino , Saúde Mental , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Osteotomia/psicologia , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/psicologia , Seleção de Pacientes , Valor Preditivo dos Testes , Recidiva , Medição de Risco , Fatores de Risco , Inquéritos e Questionários , Síndrome do Desfiladeiro Torácico/fisiopatologia , Síndrome do Desfiladeiro Torácico/psicologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
Arch Surg ; 146(12): 1383-7, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22184299


OBJECTIVE: To study the outcomes of children with thoracic outlet syndrome (TOS) treated surgically with transaxillary first-rib resection and scalenectomy (FRRS). DESIGN: A retrospective database review. SETTING: The Johns Hopkins Medical Institutions. PATIENTS: Patients 18 years or younger who had undergone FRRS. INTERVENTIONS: All patients underwent FRRS. Patients with venous TOS underwent venography 2 weeks postoperatively. Main Outcomes Measures For patients with venous TOS, good outcomes included patent subclavian veins. For patients with neurogenic and arterial TOS, good outcomes included relief of pain and discomfort. RESULTS: Thirty-five adolescents, including 14 male and 21 female patients, presented with TOS. Of these, 18 had venous symptoms, 9 had neurogenic symptoms, and 8 had arterial symptoms. Seventeen of the 18 patients with venous TOS had thrombosis. At postoperative venography, 13 patients required dilation of a stenotic vein, 2 had patent veins, and 2 had chronically occluded veins. All 18 patients had patent veins, but 1 had persistent ipsilateral neurogenic symptoms. Physical therapy before FRRS had failed in all 9 patients with neurogenic TOS. Five of the 8 patients with arterial TOS presented with abnormal ribs. Two had episodes of embolization, and 1 had an occluded radial artery. None had an axillosubclavian aneurysm. All 8 patients underwent FRRS; 3 also required removal of the fused cervical rib. All 35 patients had a favorable follow-up period. CONCLUSIONS: Adolescents present more frequently with venous and arterial TOS than do adults. However, in nearly all adolescent patients, treatment with FRRS leads to a rapid return to full activity.

Músculos do Pescoço/cirurgia , Complicações Pós-Operatórias/etiologia , Costelas/cirurgia , Síndrome do Desfiladeiro Torácico/cirurgia , Adolescente , Angioplastia com Balão , Axila/cirurgia , Constrição Patológica/cirurgia , Feminino , Humanos , Masculino , Flebografia , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Veia Subclávia/cirurgia , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Trombectomia , Terapia Trombolítica