O-044 - MIDTERM CLINICAL OUTCOMES COMPARISON BETWEEN INFRACLAVICULAR AND SUPRACLAVICULAR APPROACH IN THE MANAGEMENT OF THE THORACIC OUTLET SYNDROME

TOPIC:
Other
AUTHORS:
Brizzi V. (Vascular Surgery Unit, Centre Hospitalier Universitaire de Bordeaux ~ Bordeaux ~ France) , Thiney P.O. (Vascular Surgery Unit, Hôpital Privé Jean Mermoz ~ Lyon ~ France) , Miceli F. (Vascular Surgery Unit, Policlinico Umberto I, Sapienza University of Rome ~ Rome ~ Italy) , Cuozzo S. (Vascular Surgery Unit, Policlinico Umberto I, Sapienza University of Rome ~ Rome ~ Italy) , Liebgott M. (Vascular Surgery Unit, Hôpital Privé Jean Mermoz ~ Lyon ~ France) , Ducasse E. (Vascular Surgery Unit, Centre Hospitalier Universitaire de Bordeaux ~ Bordeaux ~ France) , Berard X. (Vascular Surgery Unit, Centre Hospitalier Universitaire de Bordeaux ~ Bordeaux ~ France) , Midy D. (Vascular Surgery Unit, Centre Hospitalier Universitaire de Bordeaux ~ Bordeaux ~ France)
Introduction:
Several surgical approaches are currently adopted for first rib resection of patients suffering from the thoracic outlet syndrome (TOS), based on surgeon preference. Benefit of the infraclavicular access has been proved for venous TOS. This study aims to evaluate the outcome of the infraclavicular approach for all types of TOS.
Methods:
A retrospective review was conducted on a cohort of patients who underwent first rib resection within the context of TOS, in two vascular surgery units adopting a different approach: infraclavicular versus supraclavicular combined with a 1,5 cm parasternal incision. Patients presenting a cervical rib or C7 transverse apophysomegaly were excluded from this study. Perioperative complications were analyzed and the functional outcome was assessed, at least 18 months after surgery, using the Quick Disability of the Arm, Shoulder and Hand (DASH) test via a telephone survey. Patients were also asked to evaluate the overall satisfaction of surgical treatment on a scale from 1 to 10. The rating was correlated with QuickDASH scores.
Results:
Between January 2018 and June 2020, 46 resections were performed on 38 patients through an infraclavicular approach (IC group) and 45 on 42 patients through a supraclavicular one (SC group). According to their medical history and physical examination 94% of patients presented a neurogenic TOS, 4% venous and 2% arterial. Adjunct procedures were performed in 4% of patients. No major complications were reported. Minor complication rate was 2% (1 pneumothorax) versus 11% (2 chylothorax, 1 Horner's syndrome, 1 pneumothorax and 1 diaphragmatic paralysis) in the IC and SC group, respectively (p=ns). At a mean follow-up of 32 months (min 18 - max 48) median QuickDASH score was 5 in the IC group and 15 in the SC group (p=ns). Scores were in line with subjective responses about the overall satisfaction (median value = 8 in both groups).
Conclusion:
The infraclavicular approach for first rib resection is a valid option in the surgical management of TOS, not only in the venous subgroup. Complications rate and functional outcome are similar to the supraclavicular approach.