Abstract
For many years, the need to resect the first rib was the only accepted approach to decompressing the thoracic outlet. However, McCleery [1] suggested that scalenectomy alone was sufficient. Accumulated experience proved this to be ineffective reinforcing the need to remove the rib. In 1966 Roos [2] designed the technique now called the transaxillary approach which allows the transection of the anterior as well as the middle scalene muscles and resection of the rib to accomplish a complete decompression of the posterior thoracic outlet, all done through an incision that is not visible from the front or the back. Since that time the operation has been performed frequently by many thoracic surgeons primarily to treat the neurogenic-arterial thoracic outlet syndrome for which this operation was principally designed.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
McCleery RS, Kersterson JE, Kirtley JA, Love RB. Subclavius and anterior scalene muscle compression as a cause of intermittent obstruction of the subclavian vein. Ann Surg. 1951;133:588–602.
Roos DB. Transaxillary approach for first rib resection to relieve thoracic outlet syndrome. Ann Surg. 1966;163:354–8.
Valentine RJ, Wind CG. Anatomic exposures in vascular surgery. Philadelphia: Lippincott Williams & Wilkins; 2003.
Urschel Jr HC, Cooper JD. Atlas of thoracic surgery. New York: Churchill Livingston; 1995.
Urschel Jr HC, Patel AN. Chapter 123. Thoracic outlet syndromes. In: Sugarbaker DJ, editor. Adult chest surgery. New York: McGraw Hill; 2009. p. 1024–33.
Mackinnon S, Patterson GA, Urschel Jr. HC. Ch 52: Thoracic outlet syndromes. In: F. Griffith Pearson, editor. Thoracic surgery. 2nd ed. New York: Churchill Livingston; 2002. p. 1393–415.
Urschel Jr HC, Razzuk MA. Chapter 18: Thoracic outlet syndrome. In: Sabiston DC, Spencer F, editors. Surgery of the chest. 5th ed. Philadelphia: Saunders; 1990. p. 536–53.
Sander RJ, Pearse WH. The treatment of thoracic outlet syndrome: a comparison of different operations. J Vasc Surg. 1989;10:626–34.
Urschel Jr HC, Razzuk MA. Neurovascular compression in the thoracic outlet: changing Âmanagement over 50 years. Ann Surg. 1998;228:609–17.
Dale A. Thoracic outlet compression syndrome. Critique in 1982. Arch Surg. 1982;117:1437–46.
Mellière D, Becquemin J-P, Etienne G, Le Cheviller B. Severe injuries resulting from operations for thoracic outlet syndrome: can they be avoided? J Cardiovasc Surg. 1991;32:599–603.
Horowitz SH. Brachial plexus injuries with causalgia resulting from transaxillary rib resection. Arch Surg. 1985;120:1189–91.
Urschel Jr HC, Razzuk MA. The failed operation for thoracic outlet syndrome: the difficulty of diagnosis and management. Ann Thorac Surg. 1986;42:523–8.
Urschel Jr HC, Razzuk MA, Albers JE, Wood RE, Paulson DL. Reoperations for recurrent thoracic outlet syndrome. Ann Thorac Surg. 1976;21:19–25.
Cheng SWK, Stoney RJ. Supraclavicular reoperation for neurogenic thoracic outlet syndrome. J Vasc Surg. 1994;19:565–72.
Sanders RJ, Haug CE, Pearce WH. Recurrent thoracic outlet syndrome. J Vasc Surg. 1990;12:390–400.
Wood VE, Twito R, Verska JM. Thoracic outlet syndrome. The results of first rib resection in 100 patients. Orthop Clin North Am. 1988;19:131–46.
Molina JE. Combined posterior and transaxillary approach for neurogenic thoracic outlet Âsyndrome. J Am Coll Surg. 1998;187:39–45.
Clagett OT. Research and prosearch. Presidential Address. J Thorac Cardiovasc Surg. 1962;44:153–66.
Ferguson TB, Burford TH, Roper CL. Neurovascular compression at the superior thoracic aperture. Surgical management. Ann Surg. 1968;167:573–9.
Altobelli GG, Kudo T, Haas BT, Chandra FA, Moy JL, Ahn SS. Thoracic outlet syndrome: pattern of clinical success after operative decompression. J Vasc Surg. 2005;42:122–8.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media New York
About this chapter
Cite this chapter
Molina, J.E. (2013). The Transaxillary Alone Approach for Removal of the First Rib. In: New Techniques for Thoracic Outlet Syndromes. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5471-7_8
Download citation
DOI: https://doi.org/10.1007/978-1-4614-5471-7_8
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-5470-0
Online ISBN: 978-1-4614-5471-7
eBook Packages: MedicineMedicine (R0)