Abstract

INTRODUCTION: Rib resection in venous thoracic outlet syndrome (VTOS) may be approached via a transaxillary, supraclavicular, or infraclavicular approach based on surgeon preference. The purpose of this study was to evaluate long-term postoperative quality of life function after surgery for VTOS and to determine if there were long term patency differences associated with the surgical approach or whether prophylactic post-operative venography was performed METHODS: All patients with vTOS undergoing rib resection at a single institution were retrospectively reviewed. In 2012 we switched our approach to infraclavicular with postoperative venogram performed within two weeks of rib resection. Clinical records and imaging results were tabulated, and postoperative outcomes, complications, and long-term symptom follow up via QuickDASH surveys. The QuickDASH score range from 0-100 with lower numbers indicating better functional status (100 = worst).RESULTS: Over the 19-year study period we performed 109 rib resections in patients with vTOS (mean age 29.8 years). From 2000 to 2012, 54 patients were approached via a supraclavicular approach and from 2012-2018, 55 patients were approached via an infraclavicular approach. There was a significant decrease in the number of complications in the infraclavicular cohort compared to the supraclavicular group. There was no difference in patency between the two groups even with a higher rate of postoperative venogram in the infraclavicular cohort. There was no difference in long term QuickDASH scores. There was an increased rate of complications in the supraclavicular cohort as compared to the infraclavicular group (P<0.05).CONCLUSION: The infraclavicular approach in vTOS patients is associated with a lower rate of complications but long-term quality of life outcomes and patency are not different between groups.

View details for DOI 10.1016/j.avsg.2019.08.071

View details for PubMedID 31476427