title: A decade of excellent outcomes after surgical intervention in 538 patients with thoracic outlet syndrome.
abstract: BACKGROUND
  Our aim was to evaluate the outcomes of patients who underwent first rib resection (FRR) for all 3 forms of thoracic outlet syndrome (TOS) during a period of 10 years.
  
  
  METHODS
  Patients treated with FRR from August 2003 through July 2013 were retrospectively reviewed using a prospectively maintained database.
  
  
  RESULTS
  Five hundred and thirty-eight patients underwent 594 FRRs for indications of neurogenic (n = 308 [52%]), venous (n = 261 [44%]), and arterial (n = 25 [4%]) TOS. Fifty-six (9.4%) patients had bilateral FRR. Fifty-two (8.8%) patients had cervical ribs. Three hundred and ninety-eight (67%) FRRs were performed on female patients, with a mean age of 33 years (range 10 to 71 years). Three hundred and forty (57%) were right-sided procedures. Seventy-five children (aged 18 years or younger) underwent FRRs; 25 during the first 5 years and 50 during the second 5 years. When comparing the second 5-year period with the first 5-year period, more patients had venous TOS (48% vs 37%; p < 0.02); fewer patients had neurogenic TOS (48% vs 58%; p < 0.05), and improved or fully resolved symptoms increased from 93% to 96%. Complications included 2 vein injuries, 2 hemothoraces, 4 hematomas, 138 pneumothoraces (23%), and 8 (1.3%) wound infections. Mean length of stay was 1 day.
  
  
  CONCLUSIONS
  Excellent results were seen in this surgical series of neurogenic, venous, and arterial TOS due to appropriate selection of neurogenic patients, use of a standard protocol for venous patients, and expedient intervention in arterial patients. There is an increasing role for surgical intervention in children.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, MD. Electronic address: morlando@jhmi.edu.
authors.forename: Megan S
authors.initials: MS
authors.lastname: Orlando
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Kendall C
authors.initials: KC
authors.lastname: Likes
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Serene
authors.initials: S
authors.lastname: Mirza
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Yue
authors.initials: Y
authors.lastname: Cao
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Anne
authors.initials: A
authors.lastname: Cohen
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Ying Wei
authors.initials: YW
authors.lastname: Lum
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Thomas
authors.initials: T
authors.lastname: Reifsnyder
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins Medical Institutions, Baltimore, MD.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Freischlag
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012272:Ribs / Q000601:surgery*; D013901:Thoracic Outlet Syndrome / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult