Surgical treatment for Neurological Thoracic Outlet Syndrome (NTOS) is considered when conservative measures, such as physiotherapy or medication, have not provided adequate relief or when the condition is causing significant neurological symptoms. It involves the decompression
of nerves in the thoracic outlet.
This is the most common surgical procedure for NTOS. It involves the removal of the first rib, which is often associated with compression of the nerves and blood vessels in the thoracic outlet.
A surgical incision is made in the neck or sometimes the axilla (armpit) under general anaesthesia. The first rib is carefully dissected and removed. In addition, the scalene muscle and other tissue bands compressing the nerves may also be removed.
In some cases, a cervical rib (an extra rib located above the first rib) can contribute to NTOS. Surgical removal of the cervical rib can alleviate compression of the nerves and blood vessels.
Recovery and rehabilitation following NTOS surgery are important for optimizing outcomes. Physical therapy and exercises to improve shoulder and neck strength and flexibility are typically prescribed to help with recovery and prevent recurrence.
Surgical treatment for Venous Thoracic Outlet Syndrome (VTOS), also known as Paget-Schroetter syndrome or effort thrombosis, is typically considered when conservative treatments have not provided adequate relief or when there is a significant risk of complications related to venous compression in the thoracic outlet such as venous thrombosis. Surgical options for VTOS treatment include
This is the most common surgical procedure for VTOS. It involves the removal of the first rib, which is often associated with compression of the vein in the thoracic outlet. A surgical incision is made in the neck or sometimes the axilla (armpit) under general anaesthesia. The first rib is carefully dissected and removed. In addition, the scalene muscle and other tissue bands compressing the vein may also be removed.
Occasionally, if a cervical rib and tissue bands are present and contributing to the compression, they are also excised and removed.
In some cases, when the compression of the subclavian artery is less severe or localized to a specific area, an endovascular approach may be considered.
Under local anaesthetic, wire and catheter are inserted through a puncture, usually in the groin. A balloon at the tip of the catheter is inflated within the narrowed or blocked portion of the subclavian artery, expanding it. In some cases, a stent (a small mesh tube) may be placed within the artery to maintain its patency and blood flow. Patientsoften require to be placed on anticoagulation (blood thinners) for a period after the surgery.
Surgical treatment for Arterial Thoracic Outlet Syndrome (ATOS) is considered when there is a significant risk of complications related to arterial compression in the thoracic outlet or embolisation (debris shooting through the arteries into the hand). Surgery aims to remove the source of the compression on the artery which is often from the first rib.
This is the most common surgical procedure for ATOS. It involves the removal of the first rib, which is often associated with compression of the artery in the thoracic outlet. A surgical incision is made in the neck or sometimes the axilla (armpit) under general anaesthesia. The first rib is carefully dissected and removed. In addition, the scalene muscle and other tissue bands compressing the nerves may also be removed.
Occasionally, if a cervical rib is present and contributing to the compression, it is also excised and removed.
In cases where the subclavian artery has been damaged or is severely compressed, it may need to be repaired or reconstructed using grafts.
In some cases, when the compression of the subclavian artery is less severe or localized to a specific area, an endovascular approach may be considered.
Under local anaesthetic, wire and catheter are inserted through a puncture, usually in the groin. A balloon at the tip of the catheter is inflated within the narrowed or blocked portion of the subclavian artery, expanding it. In some cases, a stent (a small mesh tube) may be placed within the artery to maintain its patency and blood flow.
©Copyright - All Rights Reserved 2024. VASCULARCLINIC
