RT Book, Section
A1 Lee, Fred
A1 Burt, Bryan M.
A2 Sugarbaker, David J.
A2 Bueno, Raphael
A2 Burt, Bryan M.
A2 Groth, Shawn S.
A2 Loor, Gabriel
A2 Wolf, Andrea S.
A2 Williams, Marcia
A2 Adams, Ann
SR Print(0)
ID 1170415394
T1 Supraclavicular Approach for Thoracic Outlet Syndrome
T2 Sugarbaker’s Adult Chest Surgery, 3e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260026931
LK accesssurgery.mhmedical.com/content.aspx?aid=1170415394
RD 2023/03/29
AB Thoracic  outlet  syndrome  (TOS)  is  a  condition  caused  by  the  compression  of  one  or  more  neurovascular  structures  as  they  cross  the  thoracic  outlet.  There  are  three  types  of  thoracic  outlet  syndrome—neurogenic,  venous,  and  arterial—each  with  its  own  clinical  features  and  treatment  algorithm.  Neurogenic  TOS  (nTOS)  is  by  far  the  most  common  type  of  TOS,  with  upwards  of  90%  of  all  TOS  cases  accounted  for  by  nTOS  in  large  single-institution  series.1,2  Arterial  TOS  is  the  least  common  TOS,  accounting  for  about  1%  of  cases,  and  venous  TOS  makes  up  the  difference.3  These  three  types  of  TOS  are  not  mutually  exclusive  and  can  coexist,  potentially  complicating  the  diagnostic  workup.  In  addition,  the  compression  of  the  neurovascular  bundle  can  occur  in  three  distinct  anatomic  levels:  the  interscalene  triangle,  the  costoclavicular  space,  and  the  pectoralis  minor  triangle  or  subcoracoid  space.4,5  This  chapter  addresses  the  supraclavicular  approach  to  first  rib  resection  and  scalenectomy,  which  is  well  suited  for  the  management  of  nTOS,  especially  in  the  case  of  a  cervical  rib.