The influence of choice of therapy on quality of life in patients with neurogenic thoracic outlet syndrome.

OBJECTIVES: We aimed to compare quality of life (QoL) after surgical decompression of the thoracic outlet versus non-operative therapy in patients with neurogenic thoracic outlet syndrome (N-TOS). DESIGN AND METHODS: We retrospectively identified 46 patients, diagnosed with N-TOS between 1999 and 2008. Twenty-four operated and 22 conservatively treated patients were sent questionnaires on their current symptoms and QoL. A matched control group (n = 24) of healthy individuals was selected for QoL comparison. Statistics were performed with linear and logistic regression analysis. RESULTS: ANOVA revealed a significant QoL difference between the three groups (p = 0.001). Separate analysis between groups demonstrated that all patients with N-TOS-like symptoms have a lower QoL than healthy controls (p = 0.001 resp. p < or = 0.000). No difference was found between conservatively and surgically treated patients (p = 0.26). EQ-5D response rate was 83%. Of the 24 surgically treated patients, 15 would choose surgery again in a similar situation, although 4 did not benefit in terms of symptom reduction. Symptom relief and VAS pain scores in the conservatively and surgically treated patients did not show significant differences (p = 0.95 resp. p = 0.40). CONCLUSIONS: All patients with N-TOS have a significantly decreased QoL compared with healthy individuals, regardless of the type of therapy they received. In this small study, surgical decompression fails to improve QoL in patients with N-TOS to the level measured in the healthy control group, despite symptom reduction consistent with previous reports. Variables significantly associated with outcome were duration of symptoms and localisation (variables included in the prediction model: age, sex, duration of symptoms, presence of paraesthesias, localisation, Adson's, Wright's and Roos' test, history of trauma, cervical arthrosis). In the perspective of QoL, the benefit of decompressive surgery is questionable. Improving patient selection seems imperative in order to achieve better results in our surgically treated patients.

[Endovascular prostheses and extra-anatomical bypasses to mesenteric and renal vessels in a patient with a thoraco-abdominal aortic aneurysm: a possible alternative to the standard operation]. / Endovasculaire vaatprothesen en extra-anatomische bypasses naar mesenteriale en renale vaten bij een patiënt met een thoracoabdominaal aneurysma van de aorta als alternatiefvoor de standaardoperatie.

A 57-year-old male had a thoraco-abdominal aortic aneurysm that was increasing in diameter, accompanied by pain in the right lower abdomen and groin. Ten years earlier he had had a dissecting thoraco-abdominal aneurysm that extended from the left subclavian artery to the aortic bifurcation. A CT-scan revealed further growth of the aneurysm. He was treated by an open and an endovascular operation. The distal aorta was replaced by a bifurcation prosthesis via a laparotomy, with 2 other bifurcation prostheses to 2 mesenteric and 2 renal arteries. In a second session, a carotid-subclavian bypass was constructed and the aorta was reinforced by an endograft from the left subclavian artery to the bifurcation prosthesis. Postoperatively he suffered a transient ischaemic attack, hypertension, pneumonia, and vocal cord paresis. At follow-up 1.5 years later, the patient was free of symptoms, with the exception of slight hoarseness during forced speech, and the aneurysm was totally under control. This procedure may be an alternative to the classical thoracophrenicolaparotomy.