An original less-invasive surgical treatment for arterial thoracic outlet syndrome caused by cervical rib.

BACKGROUND

Thoracic outlet syndrome affects 0.3-8% of the population, with arterial thoracic outlet syndrome being particularly rare. The management of arterial thoracic outlet syndrome requires complete thoracic outlet decompression along with arterial reconstruction when necessary, a procedure that is typically associated with significant risks, complications, and symptom recurrence. Our study aims to introduce a less invasive surgical method for treating arterial thoracic outlet syndrome caused by a cervical rib, which involves only cervical rib resection and scalenotomy.

METHODS

Patients diagnosed with isolated arterial thoracic outlet syndrome attributed to an ipsilateral cervical rib who required thoracic outlet decompression between 2015 and 2022 were included. All patients underwent supraclavicular cervical rib resection and scalenotomy without first thoracic rib resection or sympathectomy. Outcomes were assessed based on symptom recurrence and functional improvement at a two-year follow-up.

RESULTS

The cohort included 10 patients with a mean age of 29.1 years. Postoperatively, the results were promising, with no recurrence of arterial thoracic outlet syndrome symptoms, no complications, and excellent functional outcomes according to Derkash’s classification. Our modified surgical approach demonstrated favorable outcomes with minimal invasiveness, suggesting a viable alternative to traditional methods.

CONCLUSION

This less invasive surgical method for treating arterial thoracic outlet syndrome caused by a cervical rib involving only cervical rib resection and scalenotomy had excellent functional outcomes and lower complication rates. However, given the small sample size, further studies are warranted to validate these findings and to establish long-term benefits.