[The surgical treatment of thoracic outlet syndrome].
In this paper the surgical treatment of thoracic outlet syndrome (TOS) is presented.


METHODS
The investigation of 74 patients treated for vascular complications of the TOS the Paget-Schroetter syndrome and postthrombotic syndrome (27 patients), as well as upper limb ischemia and/or the subclavian artery aneurysm (14 patients) and for neurological complications of the TOS (33 patients) was performed. In case of venous thrombosis the treatment consisted of thrombolytic therapy and decompressive procedures that included transaxillary first rib resection and other surgical procedures that excise different anomalies in the region of the thoracic outlet. In case of complications associated with compression of the subclavian artery the operation consisted of resection of the first rib and accessory osseous and muscular pathological elements using supraclavicular and/or infraclavicular approach with implantation of vascular bypass were performed. In the neurological syndrome of TOS the operation consisted of transaxillary first rib resection and other surgical procedures that excise different anomalies in the region of the thoracic outlet. The therapy results were estimated with use of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire of the American Academy of Orthopedic Surgeons.


RESULTS
In case of venous complications the thrombolytic therapy was successful in all cases the restoration of complete patency was obtained. In all patients first rib was resected via transaxillary approach. The DASH questionnaire revealed the full return of upper limb function in most of patients. Improvement was obtained the in the cases with postthrombotic syndrome. In case of upper limb ischemia the improvement of blood flow was obtained after the subclavian-brachial bypass implantation (5 patients). In this group the DASH score showed return to full activity. In case of subclavian artery aneurysm surgery (9 patients) the DASH scale revealed worsening of limb function in 4 patients during the follow-up period. In the neurological syndrome of TOS the restoration of complete activity of limb was observed. The DASH scale revealed worsening of limb function in 4 patients during the follow-up period.


CONCLUSIONS
The optimal therapy of vascular complications is multimodal treatment (thrombolysis or reconstructive vascular procedure with decompressive surgery). The surgical treatment of neurological TOS halts degradation of brachial splice. The decompression of neurovascular bundle in vascular TOS should include the first rib resection in each case.
Pupka
Artur
A
Katedra i Klinika Chirurgii Naczyniowej, Ogólnej i Transplantacyjnej, Akademii Medycznej we Wrocławiu. apupka@chirn.am.wroc.pl
Ruciński
Artur
A
Rybak
Zbigniew
Z
Korta
Krzysztof
K
Zacharska
Sylwia
S
Szyber
Piotr
P
D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods; D006225:Hand / Q000098:blood supply; D006801:Humans; D011859:Radiography; D012189:Retrospective Studies; D012272:Ribs; D013348:Subclavian Artery / Q000601:surgery; D013350:Subclavian Vein / Q000601:surgery; D013901:Thoracic Outlet Syndrome / Q000000981:diagnostic imaging / Q000601:surgery*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome