title: [Thoracic Outlet Syndrome].
abstract: IntroductionThoracic outlet syndrome (TOS) is one of the most extensively discussed diagnoses. There is neither a clear and homogenous clinical presentation nor an accepted definition. The term describes a complex of symptoms and complaints caused by the compression of nerves and vascular structures at one of the three defined constrictions of the upper thoracic aperture.MethodsBased on a comprehensive literature review, this article presents the etiology, epidemiology and clinical diagnostics as well as the possibilities and outcomes of surgical treatment.ResultsThe thoracic outlet syndrome is currently subdivided into three main forms: vascular TOS (vasTOS) including arterial TOS (aTOS) and venous TOS (vTOS), neurogenic TOS (nTOS), which is further subdivided into typical (nTOS) and atypical TOS (disTOS), and a mixed form of nTOS and vasTOS (nvasTOS). The diagnosis is complex and difficult since the disTOS group comprises over 90 % of all patients. In addition to conservative treatment attempts, nTOS may be treated by surgical procedures focusing on the decompression of neurovascular structures. A significant improvement after surgery was found in up to 92 % of cases. The most common access sites are supraclavicular and transaxillary. 50 to 80 % of patients benefit from surgery in the long run. The rates of vascular or neurological complications reported by specialised centres are 0 to 2 %; minor complications such as pneumothorax, bleeding and lymphatic fistula are reported in up to 25 % of cases.SummaryMost patients suffering from any form of TOS benefit from surgical treatment. Duration of symptoms, socioeconomic factors and, most notably, stringent diagnostic workup and an adequate operative procedure performed by an experienced centre are crucial to success.
authors.affiliation: Klinik für Thorax-, Gefäß- und endovaskuläre Chirurgie, Klinikum Chemnitz gGmbH, Deutschland.
authors.forename: Sven
authors.initials: S
authors.lastname: Seifert
authors.affiliation: Klinik für Thorax-, Gefäß- und endovaskuläre Chirurgie, Klinikum Chemnitz gGmbH, Deutschland.
authors.forename: Pavel
authors.initials: P
authors.lastname: Sebesta
authors.affiliation: Klinik für Thorax-, Gefäß- und endovaskuläre Chirurgie, Klinikum Chemnitz gGmbH, Deutschland.
authors.forename: Marian
authors.initials: M
authors.lastname: Klenske
authors.affiliation: Klinik für Thorax-, Gefäß- und endovaskuläre Chirurgie, Klinikum Chemnitz gGmbH, Deutschland.
authors.forename: Mirko
authors.initials: M
authors.lastname: Esche
mesh_terms: D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome