Surgical Treatment of Thoracic Outlet Compression Syndromes: Diagnostic Considerations and Transaxillary First Rib Resection

Abstract

The thoracic outlet encompasses a unique anatomic region dominated by the first rib, the anterior and middle scalene muscles, and their associated structures. Within this relatively confined space, the subclavian artery, the subclavian vein, and the five nerve roots of the brachial plexus are all potentially subject to extrinsic compression (Fig. 1). Vascular lesions associated with thoracic outlet compression typically give rise to easily recognized syndromes, such as effort thrombosis of the subclavian vein or poststenotic aneurysms of the subclavian artery complicated by thromboembolism. In contrast, the diagnosis of neurogenic thoracic outlet compression syndrome (TOS) often remains difficult, confusing, and elusive. An increasing body of experience demonstrates that excellent results can be achieved by a comprehensive, multidisciplinary approach to neurogenic TOS, including a prominent role for surgical treatment in well-selected patients.’ Nonetheless, uncertainty in diagnosis and disappointing results of teatment have led some to question the very existence of neurogenic TOS, adding to the many controversies surrounding this condition.* The purpose of this two-part series is to outline the current management strategies and surgical