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. 2023 Sep 1;278(3):417-425.
doi: 10.1097/SLA.0000000000005957. Epub 2023 Jun 19.

Efficacy and Safety of Supraclavicular Thoracic Outlet Decompression

Nikhil Panda  1 , Jacob Hurd, James Madsen, Jacob N Anderson, Margaret E Yang, Jon Sulit, Sangkavi Kuhan, Alexandra L Potter, Yolonda L Colson, Chi-Fu Jeffrey Yang, Dean M Donahue
Affiliations

Efficacy and Safety of Supraclavicular Thoracic Outlet Decompression

Nikhil Panda et al. Ann Surg. .

Abstract

Objectives: We aimed to report efficacy, safety, and health-related quality of life (HRQoL) outcomes of a multidisciplinary treatment approach including supraclavicular thoracic outlet decompression among patients with thoracic outlet syndrome (TOS).

Background: TOS is a challenging condition where controversy remains in diagnosis and treatment, primarily given a lack of data exploring various treatment approaches and associated patient outcomes.

Methods: Patients who underwent unilateral, supraclavicular thoracic outlet decompression, or pectoralis minor tenotomy for neurogenic, venous, or arterial TOS were identified from a prospectively maintained database. Demography, use of preoperative botulinum toxin injection, and participation in multidisciplinary evaluation were measured. The primary endpoints were composite postoperative morbidity and symptomatic improvement compared with baseline.

Results: Among 2869 patients evaluated (2007-2021), 1032 underwent surgery, including 864 (83.7%) supraclavicular decompressions and 168 (16.3%) isolated pectoralis minor tenotomies. Predominant TOS subtypes among surgical patients were neurogenic (75.4%) and venous TOS (23.4%). Most patients (92.9%) with nTOS underwent preoperative botulinum toxin injection; 56.3% reported symptomatic improvement. Before surgical consultation, few patients reported participation in physical therapy (10.9%). The median time from first evaluation to surgery was 136 days (interquartile range: 55, 258). Among 864 patients who underwent supraclavicular thoracic outlet decompression, complications occurred in 19.8%; the most common complication was chyle leak (8.3%). Four patients (0.4%) required revisional thoracic outlet decompression. At a median follow-up of 420 days (interquartile range: 150, 937) 93.3% reported symptomatic improvement.

Conclusion: Based on low composite morbidity, need for very few revisional operations, and high rates of symptomatic improvement, a multidisciplinary treatment approach including primarily supraclavicular thoracic outlet decompression is safe and effective for patients with TOS.

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Conflict of interest statement

The authors report no conflicts of interest.

References

    1. Panda N, Phillips WW, Geller AD, et al. Supraclavicular approach for neurogenic thoracic outlet syndrome: description of a learning curve. Ann Thorac Surg. 2021;112:1616–1623.
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    1. Panda N, Donahue DM. Evaluation of patients with neurogenic thoracic outlet syndrome. Thorac Surg Clin. 2021;31:55–59.
    1. Donahue DM, Godoy IRB, Gupta R, et al. Sonographically guided botulinum toxin injections in patients with neurogenic thoracic outlet syndrome: correlation with surgical outcomes. Skeletal Radiol. 2020;49:715–722.

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