title: The significance of cervical ribs in thoracic outlet syndrome.
abstract: OBJECTIVE
  The purpose of this study was to review our operative experience in patients with thoracic outlet syndrome (TOS) resulting from cervical ribs causing clinical symptoms.
  
  
  METHODS
  This study is a retrospective review of a prospectively acquired database of patients with TOS treated with first rib resection and scalenectomy with or without cervical rib resection at the Johns Hopkins Medical Institutions.
  
  
  RESULTS
  Between October 2003 and June 2011, a total of 23 cervical rib resections were performed on 20 patients, three of whom had bilateral cervical ribs resected during separate operations. Seven patients presented with subclavian artery thrombosis. Three of seven patients had subclavian artery aneurysms and underwent cervical rib resection through a supraclavicular approach to facilitate subclavian artery bypass. Five patients presented with an ischemic upper extremity without thrombosis and underwent transaxillary first rib and cervical rib resection. Three patients presented with subclavian vein thrombosis; two of the three patients underwent balloon dilation 2 weeks postoperatively for stenosis. Additionally, five patients presented with neurogenic TOS evidenced by pain, numbness, and weakness without vascular compromise in the affected arm. Cervical ribs with bony fusion to the first rib were found in 17 of 23 cases (74%).
  
  
  CONCLUSIONS
  Cervical ribs causing clinical symptoms are large and frequently fused to the first rib, and can result in aneurysm formation or thrombosis. In our experience, both the cervical rib and the first rib must be removed to relieve arterial compression and can usually be done through a transaxillary approach. Only patients with aneurysms needing arterial reconstruction require resection of the artery from a supraclavicular approach.
authors: Division of Vascular and Endovascular Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
authors: Kevin Zou
authors: KZ
authors: Chang
authors: Kendall
authors: K
authors: Likes
authors: Kylie
authors: K
authors: Davis
authors: Jasmine
authors: J
authors: Demos
authors: Julie Ann
authors: JA
authors: Freischlag
mesh_terms: D000293:Adolescent; D000328:Adult; D000783:Aneurysm / Q000209:etiology / Q000601:surgery; D015142:Baltimore; D057070:Cervical Rib / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D002573:Cervical Rib Syndrome / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D011859:Radiography; D012189:Retrospective Studies; D013349:Subclavian Steal Syndrome / Q000209:etiology / Q000601:surgery; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013927:Thrombosis / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D034941:Upper Extremity / Q000098:blood supply*; D014656:Vascular Surgical Procedures; D055815:Young Adult