Ann Vasc Surg. 2025 Oct 15:S0890-5096(25)00686-7. doi: 10.1016/j.avsg.2025.10.012. Online ahead of print.
ABSTRACT
PURPOSE: Thoracic outlet syndrome (TOS) is a group of symptoms caused by compression of neurovascular structures serving the upper extremity. In patients with severe disease, disability symptoms and failed physical therapy, surgical treatment is recommended for decompression. The aim of our study was to report the safety of transaxillary approach in TOS surgery.
METHODS: We retrospectively collected demographic and clinical data for all patients that underwent surgery for TOS from January 1st 2012 to December 31th 2021 in our center.
RESULTS: Over 10 years, 346 patients underwent surgery for TOS in 484 upper limbs. The mean age was 37,9 +/- 10.6 years with 242 female (69.9%). Vascular complications were reported in 141 (29.1%) limbs with 5 (1%) acute limb ischemia, 104 (21.4%) ectasia of the subclavian artery and 32 (6.6%) venous thrombosis. Positive findings at EMG were reported in 185 (38.2%) limbs. Transaxillary approach allowed first rib removal in 466 cases (98.5%) associated with pectoralis minor section in 201 (43%) cases. Pectoralis minor section alone was performed in 7 (1.4%) cases. Twenty-four (82.7%) cervical ribs were removed, and 1 redo surgery was performed through the TA approach. At 6-weeks, neurological injuries were reported in 2 (0.5%) cases with one C8-T1 injury and one axillary nerve injury. No phrenic nerve or long thoracic nerve or dorsal scapular nerve were reported. Hemothorax requiring reintervention were reported in 13 (2.7%) cases, pneumothorax requiring chest tube in 21 (4.3%). Medial brachial nerve palsy was reported in 57 (11.7%) cases.
CONCLUSION: Transaxillary approach in TOS surgery allows complete first rib resection with access to the posterior part of the first rib. We confirm its safety especially regarding neurological complications. Diagnostic criterions and functional results need more evaluations but these further results we are willing to report are conditioned to the safety of our practice.
PMID:41106672 | DOI:10.1016/j.avsg.2025.10.012