Abstract
Background Our aim was to evaluate the outcomes of patients who underwent first rib resection (FRR) for all 3 forms of thoracic outlet syndrome (TOS) during a period of 10 years. Study Design Patients treated with FRR from August 2003 through July 2013 were retrospectively reviewed using a prospectively maintained database. Results Five hundred and thirty-eight patients underwent 594 FRRs for indications of neurogenic (n = 308 [52%]), venous (n = 261 [44%]), and arterial (n = 25 [4%]) TOS. Fifty-six (9.4%) patients had bilateral FRR. Fifty-two (8.8%) patients had cervical ribs. Three hundred and ninety-eight (67%) FRRs were performed on female patients, with a mean age of 33 years (range 10 to 71 years). Three hundred and forty (57%) were right-sided procedures. Seventy-five children (aged 18 years or younger) underwent FRRs; 25 during the first 5 years and 50 during the second 5 years. When comparing the second 5-year period with the first 5-year period, more patients had venous TOS (48% vs 37%; p < 0.02); fewer patients had neurogenic TOS (48% vs 58%; p < 0.05), and improved or fully resolved symptoms increased from 93% to 96%. Complications included 2 vein injuries, 2 hemothoraces, 4 hematomas, 138 pneumothoraces (23%), and 8 (1.3%) wound infections. Mean length of stay was 1 day. Conclusions Excellent results were seen in this surgical series of neurogenic, venous, and arterial TOS due to appropriate selection of neurogenic patients, use of a standard protocol for venous patients, and expedient intervention in arterial patients. There is an increasing role for surgical intervention in children.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 934-939 |
| Number of pages | 6 |
| Journal | Journal of the American College of Surgeons |
| Volume | 220 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 1 2015 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Surgery
Cite this
A decade of excellent outcomes after surgical intervention in 538 patients with thoracic outlet syndrome. / Orlando, Megan S.; Likes, Kendall C.; Mirza, Serene; Cao, Yue; Cohen, Anne; Lum, Ying Wei; Reifsnyder, Thomas; Freischlag, Julie A.
In: Journal of the American College of Surgeons, Vol. 220, No. 5, 01.05.2015, p. 934-939.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - A decade of excellent outcomes after surgical intervention in 538 patients with thoracic outlet syndrome
AU - Orlando, Megan S.
AU - Likes, Kendall C.
AU - Mirza, Serene
AU - Cao, Yue
AU - Cohen, Anne
AU - Lum, Ying Wei
AU - Reifsnyder, Thomas
AU - Freischlag, Julie A.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Background Our aim was to evaluate the outcomes of patients who underwent first rib resection (FRR) for all 3 forms of thoracic outlet syndrome (TOS) during a period of 10 years. Study Design Patients treated with FRR from August 2003 through July 2013 were retrospectively reviewed using a prospectively maintained database. Results Five hundred and thirty-eight patients underwent 594 FRRs for indications of neurogenic (n = 308 [52%]), venous (n = 261 [44%]), and arterial (n = 25 [4%]) TOS. Fifty-six (9.4%) patients had bilateral FRR. Fifty-two (8.8%) patients had cervical ribs. Three hundred and ninety-eight (67%) FRRs were performed on female patients, with a mean age of 33 years (range 10 to 71 years). Three hundred and forty (57%) were right-sided procedures. Seventy-five children (aged 18 years or younger) underwent FRRs; 25 during the first 5 years and 50 during the second 5 years. When comparing the second 5-year period with the first 5-year period, more patients had venous TOS (48% vs 37%; p < 0.02); fewer patients had neurogenic TOS (48% vs 58%; p < 0.05), and improved or fully resolved symptoms increased from 93% to 96%. Complications included 2 vein injuries, 2 hemothoraces, 4 hematomas, 138 pneumothoraces (23%), and 8 (1.3%) wound infections. Mean length of stay was 1 day. Conclusions Excellent results were seen in this surgical series of neurogenic, venous, and arterial TOS due to appropriate selection of neurogenic patients, use of a standard protocol for venous patients, and expedient intervention in arterial patients. There is an increasing role for surgical intervention in children.
AB - Background Our aim was to evaluate the outcomes of patients who underwent first rib resection (FRR) for all 3 forms of thoracic outlet syndrome (TOS) during a period of 10 years. Study Design Patients treated with FRR from August 2003 through July 2013 were retrospectively reviewed using a prospectively maintained database. Results Five hundred and thirty-eight patients underwent 594 FRRs for indications of neurogenic (n = 308 [52%]), venous (n = 261 [44%]), and arterial (n = 25 [4%]) TOS. Fifty-six (9.4%) patients had bilateral FRR. Fifty-two (8.8%) patients had cervical ribs. Three hundred and ninety-eight (67%) FRRs were performed on female patients, with a mean age of 33 years (range 10 to 71 years). Three hundred and forty (57%) were right-sided procedures. Seventy-five children (aged 18 years or younger) underwent FRRs; 25 during the first 5 years and 50 during the second 5 years. When comparing the second 5-year period with the first 5-year period, more patients had venous TOS (48% vs 37%; p < 0.02); fewer patients had neurogenic TOS (48% vs 58%; p < 0.05), and improved or fully resolved symptoms increased from 93% to 96%. Complications included 2 vein injuries, 2 hemothoraces, 4 hematomas, 138 pneumothoraces (23%), and 8 (1.3%) wound infections. Mean length of stay was 1 day. Conclusions Excellent results were seen in this surgical series of neurogenic, venous, and arterial TOS due to appropriate selection of neurogenic patients, use of a standard protocol for venous patients, and expedient intervention in arterial patients. There is an increasing role for surgical intervention in children.
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U2 - 10.1016/j.jamcollsurg.2014.12.046
DO - 10.1016/j.jamcollsurg.2014.12.046
M3 - Article
VL - 220
SP - 934
EP - 939
JO - Journal of the American College of Surgeons
JF - Journal of the American College of Surgeons
SN - 1072-7515
IS - 5
ER -