This journal is
indexed in Scopus
Year 2014 Vol. 22 No 4
GENERAL AND SPECIAL SURGERY
D.D. SULTANOV1,2, F.M. TUHTAEV 1, N.R. KURBANOV 2
TRANSAXILLARY FIRST RIB RESECTION AT COSTOCLAVICULAR SYNDROME
Republican Scientific Center of Cardiovascular Surgery of Ministry of Health and Social Protection of the Republic of Tajikistan1
Avicenna Tajik State Medical University2, Dushanbe
The Republic of Tajikistan
Objectives. To improve the method of transaxillary first rib resection at the costoclavicular syndrome (CCS).
Methods. The results of survey and surgical treatment of patients (n=77) with Falconer-Weddell costoclavicular syndrome have been analyzed.
The tests of Edson, Lange, Roos, Wright have been carried out to reveal the signs of compression of the neurovascular bundle (NVB) and differentiation of the compression level. Neurological tests have been defined for neurological disorders. In patients with the secondary Raynaud's syndrome to predict the outcome of operation the cold and nitroglycerine tests were done. Methods of investigations included Doppler ultrasound and X-ray examinations. In 58 (75,3%) of 77 patients with CCS the signs of Raynaud's syndrome were observed besides the enumerated symptoms. All patients were operated on under endotracheal anesthesia. Decompression operations have been conducted in all patients (n=77); selective cervico-thoracic sympathectomy – in 58 cases.
Results. The pleura damage during the operation was registered in 4 (5,2%) patients. Non-specific complications such as hemothorax (n=1) and wound bleeding after surgery with festering it further (n=1) have been occurred. In the postoperative period the brachial plexitis manifested by pain in the arm and neck regions which was stopped with anti-inflammatory, anesthetic agents was observed in 3 patients. All above-mentioned complications were transient in 9 (11,7%) patients. The gradual regression of the neurological symptoms and arterial disturbances was noticed. In the long-term period the positive results were registered in all operated patients, the certain symptoms were recurred in some of them in winter season.
Conclusions. Transaxillary first rib resection despite of some technical difficulties of performance is considered as a highly-effective and pathogenetically grounded method of costoclavicular syndrome treatment. The decompression effect has been achieved on all three anatomically “narrow” for compression areas.
- Abyshov NS, Mamedov AM. Diagnostika i lechenie sindroma grudnogo vykhoda [Diagnosis and treatment of thoracic outlet syndrome. Khirurgiia. 2007;(6):68–72.
- Shalimov AA, Driuk NF, Oleinik LI, Polishchuk IuE. Khirurgicheskoe lechenie neirososudistogo kompressionnogo sindroma grudnogo vykhoda [Surgical treatment of neurovascular compression syndrome of thoracic outlet]. Khirurgiia. 1987;(7):1–4.
- Aralasmak A, Cevikol C, Karaali K, Senol U, Sharifov R, Kilicarslan R, Alkan A. MRI findings in thoracic outlet syndrome. Skeletal Radiol. 2012 Nov;41(11):1365–74.
- Dahlstrom KA, Olinger AB. Descriptive anatomy of the interscalene triangle and the costoclavicular space and their relationship to thoracic outlet syndrome: a study of 60 cadavers. J Manipulative Physiol Ther. 2012 Jun;35(5):396–401.
- Peet RM, Henriksen JD, Anderson TD, Martin GM. Thoracic outlet syndrome: Evalution of a therapeutic exercise program. Proc Staff Meet Mayo Clin. 1956 May 2;31(9):281–87.
- Lur'e AS. Khirurgiia plechevogo spleteniia [Brachial plexus surgery]. Moscow, SSSR: Meditsina. 1968. 215 p.
- Falconer MA, Weddel LG. Costoclavicular compression of the subclavian artery and vein. Lancet. 1943;(2):539–43.
- Petrov VI. Narushenie krovoobrashcheniia pri kompressionnom sindrome grudnogo vykhoda [Disturbance of a circulation in thoracic outlet compression syndrome]. Klin Khirg. 2000;(10):11–12.
- Illig KA, Doyle AJ. A comprehensive review of Paget-Schroetter syndrome. J Vasc Surg. 2010 Jun;51(6):1538–47.
- Thompson RW. Comprehensive management of subclavian vein effort thrombosis. Semin Intervent Radiol. 2012 Mar;29(1):44–51.
- Fantini GA. Reserving supraclavicular first rib resection for vascular complications of thoracic outlet syndrome. Am J Surg. 1996 Aug;172(2):200–4.
- Melliere D, Becquemin JP, Etienne G. [Article in French] [Complications of surgery of the thoraco-cervico-brachial outlets]. J Chir (Paris). 1985 Mar;122(3):151–57.
- Qvarordt PG, Ehrenfeld WK, Stoney RJ. Supraclavicular radical scalenectomy and transaxillary first rib resection for the thoracic outlet syndrome: A combined approach. Am JSurg. 1984;(148):111–16.
- Urschel HC, Kourlis H. Thoracic outlet syndrome: a 50-year experience at Baylor University Medical Center. Proc (Bayl Univ Med Cent). 2007 Apr;20(2):125–35.
- Arakelian VS, Malinin AA, Pulatov ON. Klassifikatsiia sindroma kompressii sosudisto-nervnogo puchka na vykhode iz grudnoi kletki [Compression syndrome classification of neurovascular bundle at the thoracic outlet]. Biulleten' NTs SSKh im AN Bakuleva RAMN. Serd-sosud zab. 2006;7(5):117 p.
- Bondarev VI, Kiandarian AK, Ablitsov NP, Baziak AP. Dinamicheskie i funktsional'nye proby v diagnostike i lechenii kompressionnykh stenozov perifericheskikh arterii [Dynamic and functional tests in the diagnosis and treatment of peripheral arterial compression stenos]. Vestn Khir. 1994;(1-2):127–28
34003, Respublika Tadzhikistan, g. Dushanbe, ul. Sanoi, d. 33, Tadzhikskiy gosudarstvennyiy meditsinskiy universitet im. Abuali ibni Sino, kafedra khirurgicheskih bolezney,
Sultanov Dzhavli Davronovich
Sultanov D.D. MD, professor of the chair of surgical diseases ¹2 of Avicenna Tajik State Medical University, a head of the Science department of Republican Scientific Center of Cardiovascular Surgery.
Tuhtaev F.M. A post-graduate student of Republican Scientific Center of Cardiovascular Surgery.
Kurbanov N.R. PhD, an assistant of the chair of surgical diseases ¹2 of Avicenna Tajik State Medical University.