Outcomes following Operative Management of Thoracic Outlet Syndrome in Pediatric Patients
Jesus M Matos, Mun Jye Poi, Shin Y Jiang, Carlos Bechara, Panagiotis Kougias, Angela Escheverria, Peter H Lin
Baylor College of Medicine, Houston, TX
INTRODUCTION: Thoracic outlet syndrome (TOS), a condition commonly reported in the adult population with upper extremity neurovascular compressive symptoms, occurs infrequently in the pediatric population. The objective of this study was to assess the outcome of surgical interventions of TOS in pediatric patients.
METHODS: Clinical records of all pediatric patients with TOS who underwent operative repair from 2002 to 2013 were reviewed. Pertinent clinical variable and treatment outcome were analyzed.
RESULTS: Forty three patients underwent a total of 49 TOS operations (mean age 16.3 years, 29 females). Venous, neurogenic, and arterial TOS occurred in 25 (58%), 11 (26%), and 7 (16%) patients, respectively. Eight patients (32%) with venous TOS had underlying hypercoagulable disorders while two patients (18%) with neurogenic TOS had concomitant pectoral minor syndrome. Twenty patients (80%) with venous TOS underwent catheter-directed thrombolysis followed by surgical decompression. Concomitant temporary arteriovenous fistula (AVF) creation was performed in 18 patients with central venous occlusion. All patients underwent first rib resection with scalenectomy via either a supraclavicular approach (43%) or combined supraclavicular and infraclavicular incisions (57%). Concomitant pectoral minor muscle resection was performed in two patients (18%) with neurogenic TOS.
Immediate symptomatic improvement was evident in 38 patients (88%) following surgical decompression. Long-term symptomatic relief was achieved in 41 patients (95%).
CONCLUSIONS: Venous TOS occurs more frequently than neurogenic
TOS, while arterial TOS occurs least frequently in pediatric patients.
Catheter-based thrombolysis and hypercoagulable evaluation are essential prior to surgical treatment of venous TOS. Concomitant temporary AVF creation was useful in venous TOS patients with subclavian vein occlusion. Surgical decompression with first rib resection with scalenectomy is effective in pediatric patients with vasculogenic TOS.
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