ABSTRACT
Objective: The aim of this study is to evaluate the results of different modalities of treatment of neurovascular compression manifestations of thoracic outlet syndrome [TOS]
Patients and methods: This prospective study included 50 patients with neuro and / or vascular compression manifestations at thoracic outlet area. They were admitted to the Vascular Surgery Unit, Mansoura, University Hospital, Mansoura, Egypt, during the period from January 2000 to May 2003. Patients were classified into two main groups. Group I [Neurogenic TOS, 35 patients with 40 limbs]: included patients presenting mainly with neurogenic manifestations. Scalenectomy +/- cx. rib excision was done in 22 limbs and combined Scalenectomy + cx. rib in addition to 1St rib excision was done in 18 limb. Group IIA [arterial TOS, 9 patients with 10 limbs]: This group included patients presenting mainly with arterial manifestations. They were subjected to surgical decompression, various methods of arterial reconstruction +/- sympathectomy. Group IIB [venous TOS, 6 patients]: This group included patients presenting mainly with arterial manifestations. They were subjected to surgical decompression, various methods of arterial reconstruction +/- sympathectomy
Results: For neurogenic group: The outcome for patients treated by scalenectomy +/- cervical rib excision was excellent in 14 limbs, good in 6 limbs and fair in 2 limbs. However, the outcome for patients treated by combined scalenectomy + cervical rib excision in addition to first rib excision was excellent in 11 limbs, good in 4 limbs and fair in 3 limbs. For arterial group: The come was excellent in 8 limbs and good in 2 limbs. For venous group: Surgical decompression in the form of scalenectomy, venolysis and 1St rib excision was done for 2 patients and the outcome was good. Conservative treatment and also P.T.A. showed failure in two patients [out of the five thrombotic patients [40%]]
Conclusion: In patients with TOS scalenectomy +/- cervical rib excision is as effective as combined scalenectomy and first rib excision ,however ,first rib excision is still indicated where there is tight costoclavicular space after scalenctomy, and also is indicated in patients with vascular manifestations
Patients and methods: This prospective study included 50 patients with neuro and / or vascular compression manifestations at thoracic outlet area. They were admitted to the Vascular Surgery Unit, Mansoura, University Hospital, Mansoura, Egypt, during the period from January 2000 to May 2003. Patients were classified into two main groups. Group I [Neurogenic TOS, 35 patients with 40 limbs]: included patients presenting mainly with neurogenic manifestations. Scalenectomy +/- cx. rib excision was done in 22 limbs and combined Scalenectomy + cx. rib in addition to 1St rib excision was done in 18 limb. Group IIA [arterial TOS, 9 patients with 10 limbs]: This group included patients presenting mainly with arterial manifestations. They were subjected to surgical decompression, various methods of arterial reconstruction +/- sympathectomy. Group IIB [venous TOS, 6 patients]: This group included patients presenting mainly with arterial manifestations. They were subjected to surgical decompression, various methods of arterial reconstruction +/- sympathectomy
Results: For neurogenic group: The outcome for patients treated by scalenectomy +/- cervical rib excision was excellent in 14 limbs, good in 6 limbs and fair in 2 limbs. However, the outcome for patients treated by combined scalenectomy + cervical rib excision in addition to first rib excision was excellent in 11 limbs, good in 4 limbs and fair in 3 limbs. For arterial group: The come was excellent in 8 limbs and good in 2 limbs. For venous group: Surgical decompression in the form of scalenectomy, venolysis and 1St rib excision was done for 2 patients and the outcome was good. Conservative treatment and also P.T.A. showed failure in two patients [out of the five thrombotic patients [40%]]
Conclusion: In patients with TOS scalenectomy +/- cervical rib excision is as effective as combined scalenectomy and first rib excision ,however ,first rib excision is still indicated where there is tight costoclavicular space after scalenctomy, and also is indicated in patients with vascular manifestations