Treatment of Thoracic Outlet Syndromes and Cervical Sympathectomy

Abstract

The thoracic outlet is a unique anatomic region dominated by the first rib, the anterior and middle scalene muscles, and their associated neurovascular structures. Within this relatively confined space, the subclavian artery, subclavian vein, and nerve roots of the brachial plexus are all potentially subject to extrinsic compression. Whereas vascular lesions associated with thoracic outlet compression give rise to easily recognized syndromes, such as effort thrombosis of the subclavian vein or thromboembolism resulting from poststenotic aneurysms of the subclavian artery, the diagnosis of neurogenic thoracic outlet syndrome (TOS) often remains difficult, confusing and elusive. Nonetheless, it is possible to achieve excellent results for all forms of TOS by a comprehensive treatment approach, which includes a prominent role for surgical treatment in well-selected patients.