Vascular thoracic outlet syndrome (VTOS), encompassing both venous and arterial subtypes, arises from extrinsic compression of the subclavian vessels within the thoracic outlet, leading to significant morbidity. Surgical decompression remains the definitive treatment to restore vascular patency and relieve neurovascular compromise. This study analyzed the long-term outcomes of surgical management of VTOS over a twenty-year period, focusing on vessel patency, recurrence, functional recovery, and procedure-related complications. A retrospective review was conducted on 325 patients (72.9% female; mean age, 37.7 ± 10.2 years) who underwent supraclavicular decompression with first-rib resection and scalenectomy between 2005 and 2025. Preoperative evaluation included duplex ultrasonography, radiography, and magnetic resonance imaging. Outcomes assessed were recurrence, vascular patency, and functional recovery using the Disabilities of the Arm, Shoulder and Hand (DASH) score, with follow-up extending to 48 months. Upper-limb edema (48.6%) and heaviness with activity (46.2%) were the most frequent presenting symptoms. Cervical ribs were present in 32.3% of cases. All patients underwent first-rib resection and scalenectomy; 32.0% required additional cervical rib excision with or without venolysis, sympathectomy, or thrombectomy. The mean operative time was 54.9 min (range: 50–90), with minimal blood loss and no intraoperative mortality. Mean DASH scores improved from 49.1 ± 4.0 to 20.0 ± 2.9 postoperatively. The recurrence rate was 3.7%, with over 95% recurrence-free survival and 90% vessel patency at 48 months. Standardized supraclavicular decompression with first-rib resection and scalenectomy offers durable symptomatic relief, excellent long-term vascular patency, and low morbidity for both arterial and venous VTOS.
Omer et al. (Fri,) studied this question.