Multiple surgical approaches exist in performing a first rib resection to treat venous thoracic outlet syndrome (vTOS). This involves a transaxillary, supraclavicular or an infraclavicular approach. Multiple studies published in the medical literature have reported on the advantages of the infraclavicular approach. We performed an audit in our centre looking at the outcomes on the infraclavicular approach for vTOS decompression.

This is a retrospective study looking at patients who underwent an infraclavicular approach for vTOS decompression from 1 Jan 2011 till 1 December 2021. Patients were identified from our local electronic surgical audit system and data were obtained from electronic records. There are two groups of patients in this study. The first group of patients are those who present with an acute subclavian thrombosis (Paget-Schroetter syndrome). The second group are patients presenting with symptomatic venous TOS defined as severe stenosis (>70%) or occlusion of the subclavian vein on stress positioning confirmed on venous duplex ultrasound.

A total of 26 patients were identified. The median age was 32 years old and 54% were males. The median surgical time is 76.5minutes. In the peri-operative period, 74% of patients had no complications. The two most common complication encountered in the peri-operative period are pleural breach and vessel re-thrombosis (12%). Follow-up at 30-days showed that 73% of patients had no complications. Arm swelling is the most commonly reported complication at follow-up in 30 days. 73% of the patients in the study underwent a follow-up USS at 30 days. In this subset of patients, the patency rate was found to be 58%.

Infraclavicular approach appears to be a safe method in performing a first rib resection with low post-operative complications. It provides a better exposure of the subclavian vein to allow for a successful decompression to be performed.

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