[Thoracic outlet syndrome--an interdisciplinary topic. Experience with diagnosis and therapy in a 15-year patient cohort (80 trans-axillary resections of the 1st rib in 67 patients) and a literature review].

Because of its wide variety of symptoms, the neurovascular compression syndrome of the upper thoracic aperture or thoracic outlet syndrome (TOS) has to be distinguished from several differential diagnoses, especially orthopedic ones. It is mainly characterized by pressure lesion of the brachial plexus and secondly, by accompanying vascular damages. An indication for surgery exists in cases of persisting or increasing complaints or function loss of shoulder, arm or hand muscles as well as in cases with occurrence of vascular damage. The treatment of choice consists of transaxillary resection of the first rib. This report presents a record of our results after transaxillary surgery and compares them to the results given in current international literature. During the last few years 3031 cases of transaxillary resections (13-473 cases) were described in international literature. The average follow-up period was 7.8 years (2-22 years). The results were good in 81.4% (50-93%) of the cases. From 02/80 to 03/94, we treated 67 patients with altogether 80 thoracic outlet syndromes (TOS). Each of them was treated similarly with extensive transaxillary resection of the first rib, excision of fibrous bands and, if necessary, of cervical ribs. Our results after surgery (84.5% of complete resolution or improvement of symptoms) compare favorably to those given by other authors. The average follow-up period was 6.6 years (0.5-14 years). Our results confirm, that transaxillary resection of the first rib is the method of choice in the treatment of thoracic outlet syndromes.