title: Thoracic outlet syndrome: influence of personal history and surgical technique on long-term results.
abstract: OBJECTIVE
  Long-term results after surgery for thoracic outlet syndrome (TOS) are reviewed in terms of personal histories and surgical techniques.
  
  
  METHODS
  Forty-eight operations were performed in 37 patients. In 21 instances, the picture was one of ordinary TOS, in eight TOS was traumatic and in nine the picture was sub-acute. Cervical ribs were excised through a supraclavicular approach (in seven cases), and first ribs through transthoracic, transaxillary or supraclavicular approaches (in 25, 15 or one, respectively). Long-term follow-up was obtained in 41 cases and averaged 11.7 years.
  
  
  RESULTS
  Surgical decompression was successful in 28 cases (68%), including all patients with traumatic TOS (8/8) and seven with sub-acute symptoms (7/9). Outcome was good in five of seven supraclavicular cervical rib resections, and in 23 of 34 first rib excisions. First rib resections performed transaxillary had shorter post-operative stays, fewer complications.
  
  
  CONCLUSIONS
  Surgical decompression is more successful when TOS is traumatic or sub-acute. When involved, a cervical rib can be resected through a supraclavicular approach, since the procedure is easy and has little morbidity. The transaxillary approach should be preferred for first rib resections because of shorter post-operative stays and fewer complications than after the transthoracic approach.
authors.affiliation: Unit of Thoracic Surgery, Geneva University Hospital, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Toso
authors.forename: J
authors.initials: J
authors.lastname: Robert
authors.forename: T
authors.initials: T
authors.lastname: Berney
authors.forename: F
authors.initials: F
authors.lastname: Pugin
authors.forename: A
authors.initials: A
authors.lastname: Spiliopoulos
mesh_terms: D000293:Adolescent; D000328:Adult; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013901:Thoracic Outlet Syndrome / Q000601:surgery*; D016896:Treatment Outcome