BACKGROUND: Patients with thoracic outlet syndrome. can present neurogenic, venous, and/o arterialsymptoms due to compression of the neurovascular structures by the scalene muscle, first rib, or fibrous bands. METHODS: Twenty-six patients underwent decompressive surgery of the thoracic outlet via the supraclavicular approach. The indication for operation was compression of the subclavian artery in 7 instances (5 females and 2 males, aged 44Â±9), axillo-subclavian venous thrombosis in 6 instances (5 females and 1 male, aged 22Â±4), and brachial plexus irritation in 13 instances (9 females and 4 males, aged 35Â±6). Operation consisted of resection of the anterior scalene and medial aspect of the middle scalene muscles and brachial plexus neurolysis for neurogenic indication, with first rib resection reserved for vascular complications. RESULTS: Clinical evaluation including a history and physical examination followed by catheter-based venography to confirm or exclude the diagnosis and allowing for immediate treatment using thrombolysis. After thrombolysis, to prevent early recurrent thrombosis, patients should be maintained with systemic anticoagulation and surgery should be performed earlier in patients with severe residual SCV stenosis. CONCLUSIONS: Early diagnosis and thrombolytic therapy followed by operative first-rib resection produces the most favorable long-term outcome for the patients
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