Our Summary

This study looked at the outcomes of a specific surgical procedure, transaxillary first rib resection (TFRR), on patients who have a condition called venous thoracic outlet syndrome (VTOS) and whose veins under the collarbone are completely blocked. The patients were divided into three groups based on how long their veins had been blocked before the surgery: less than 4 weeks, 4 to 12 weeks, and more than 12 weeks. The researchers then looked at how many of these veins were opened up again one year after surgery and how much the patients’ symptoms improved.

They found that the surgery worked well for all patients, regardless of how long their veins had been blocked. Most of the patients experienced symptom relief, and around three-quarters of them had their veins successfully opened. They also found that the use of a balloon to open up more narrowed or blocked veins after surgery was successful. Overall, this study suggests that this surgery is a good treatment option for patients with this condition, even if their veins are completely blocked.

FAQs

  1. What is the transaxillary first rib resection (TFRR) surgery?
  2. How effective is the TFRR surgery in treating venous thoracic outlet syndrome (VTOS) for patients with completely blocked veins under the collarbone?
  3. Does the duration of vein blockage before surgery affect the success of the TFRR procedure?

Doctor’s Tip

A doctor might tell a patient undergoing thoracic outlet syndrome surgery to follow their post-operative care instructions carefully to ensure the best possible outcome. This may include managing pain, attending physical therapy appointments, and avoiding activities that could put strain on the surgical site. It is important to communicate any concerns or changes in symptoms to your healthcare provider to ensure proper healing and recovery.

Suitable For

Patients who are typically recommended thoracic outlet syndrome surgery are those who have not responded to conservative treatments such as physical therapy, medication, and lifestyle modifications. The surgery may be recommended for patients with severe symptoms such as chronic pain, numbness and tingling in the arm, weakness, and difficulty performing daily activities.

In particular, patients with venous thoracic outlet syndrome (VTOS) who have completely blocked veins under the collarbone may be candidates for surgery, especially if their symptoms are severe and affecting their quality of life. The study mentioned above focused on patients with this specific condition and found that the surgery was effective in improving symptoms and restoring vein function.

It is important for patients to undergo a thorough evaluation by a medical professional to determine if surgery is the best treatment option for their specific case. The decision to undergo surgery should be made in consultation with a healthcare provider who can provide guidance on the potential risks and benefits of the procedure.

Timeline

Before thoracic outlet syndrome surgery:

  • Patient experiences symptoms such as pain, numbness, tingling, and weakness in the arm, shoulder, and hand
  • Patient undergoes diagnostic tests such as imaging studies and nerve conduction studies to confirm the diagnosis of thoracic outlet syndrome
  • Patient may undergo conservative treatments such as physical therapy, medication, and lifestyle modifications to manage symptoms

After thoracic outlet syndrome surgery:

  • Patient undergoes transaxillary first rib resection (TFRR) surgery to address the compression of blood vessels and nerves in the thoracic outlet
  • Patient may experience pain and discomfort immediately after surgery, which is managed with pain medication
  • Patient undergoes physical therapy to regain strength and range of motion in the affected arm
  • Patient experiences gradual improvement in symptoms such as pain, numbness, and weakness
  • Patient follows up with their healthcare provider for post-operative care and monitoring of their progress
  • Patient may need additional procedures such as balloon angioplasty to further open up narrowed or blocked veins
  • Patient continues to follow up with their healthcare provider for long-term management of thoracic outlet syndrome symptoms

What to Ask Your Doctor

  1. What are the potential risks and complications associated with thoracic outlet syndrome surgery?
  2. What is the success rate of this specific surgical procedure for patients with venous thoracic outlet syndrome?
  3. How long is the recovery process after the surgery, and what can I expect in terms of pain and discomfort?
  4. Will I need physical therapy or rehabilitation after the surgery to regain strength and mobility in my arm?
  5. Are there any alternative treatments or non-surgical options that I should consider before proceeding with surgery?
  6. How long will the effects of the surgery last, and will I need additional procedures in the future?
  7. What is the likelihood of recurrence of symptoms after the surgery, and what can be done to prevent this?
  8. How experienced is the surgical team in performing this specific procedure, and what is their success rate with similar cases?
  9. Are there any specific lifestyle changes or modifications that I will need to make after the surgery to support my recovery and prevent future issues?
  10. Can you provide me with information about post-operative follow-up care and support, including when I should schedule follow-up appointments and what symptoms should prompt immediate medical attention?

Reference

Authors: Ng JC, Tan LT, Mofid A, Holscher CM, White JM, Hicks CW, Abularrage CJ, Freischlag JA, Lum YW. Journal: J Vasc Surg Venous Lymphat Disord. 2024 Sep;12(5):101925. doi: 10.1016/j.jvsv.2024.101925. Epub 2024 Jun 22. PMID: 38914374