Barnaby Farquharson

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Title: 17 years experience of surgical management of Thoracic Outlet Syndrome at a District General Hospital

Introduction: Thoracic outlet syndrome (TOS) is caused by compression of the neurovascular structures passing through the thoracic inlet. It is categorised into three subtypes: neurogenic TOS (NTOS), venous TOS (VTOS) and arterial TOS (ATOS). This study evaluates the outcomes of patients undergoing First Rib Resection (FRR) for Thoracic Outlet Syndrome (TOS) during a period of 17 years at a single District General Hospital (DGH).
Methods: Retrospective review of patient notes of individuals treated with FRR from August 2004 through to August 2021.
Results: A total of 62 FRR were performed on 51 individual patients. Indications for FRR included 42 neurogenic TOS (68%), 6 venous TOS (10%) and 14 arterial TOS (23%). 34 patients (64%) were female and the mean age at time of surgery was 39 years old (range 27 to 64 years). 11 patients (21%) underwent bilateral FRR and 7 cases of cervical ribs were observed. The mean time from initial symptoms to diagnosis was 18 months (2 to 60 months). Overall, outcomes after surgery were positive across all subtypes of TOS. Based on the Derkash’s classification; 52 (84%) reported excellent/good, 8 (13%) reported fair and 2 (3%) reported poor resolution of symptoms at 6 month follow up. Complications included 4 (9%) pneumothorax, 2 (4%) wound infections, 2 (4%) seromas, 1 (2%) haemothorax, 3 (5%) phrenic nerve complications and 1 (2%) chronic pain.
Conclusions: This series exemplifies the diagnostic difficulty associated with TOS with patients often waiting prolonged periods of time before definitive treatment. FRR for TOS can be performed safely and effectively in a DGH environment with excellent patient clinical outcomes.


KSS Vascular Trainee, Clinical Research Fellow

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