Transaxillary decompression of thoracic outlet syndrome: A single-center study

Objective: Transaxillary approach for the surgical management of thoracic outlet syndrome (TOS) has the advantage of minimal manipulation of brachial plexus and lesser perioperative and postoperative complications. We studied the clinical presentation and transaxillary surgical excision of the first rib in TOS at our center. Materials and Methods: All patients with TOS were reviewed for their clinical presentation and outcomes of transaxillary approach for thoracic outlet decompression over a period of 10 years. We evaluated the clinical presentation, surgical details, and postoperative course of all patients who underwent surgery. Results: Sixty-three patients of TOS were studied who underwent decompression through transaxillary approach over a period of 10 years. Nearly 79.4% of the patients had neurological symptoms, whereas 20.6% had arterial symptoms. Almost all patients (98.4%) had a cervical rib. One-fourth of the study population had bilateral cervical ribs. Around 17.46% of the patients presented with acute thromboembolism of the brachial artery and were managed with emergency thromboembolectomy. Postoperative complications encountered were pleural breach (11.11%), wound infection (7.94%), and re-thrombosis (1.59%). Conclusions: Transaxillary resection of the cervical/ first rib has excellent results, with less morbidity. It is efficient in relieving symptoms and gives cosmetically acceptable scar. It is proposed that whenever any patient presents with acute upper-limb ischemia, he/she must be evaluated for cervical rib as a cause of TOS.