Thoracic Outlet Syndrome: Transaxillary Approach

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Presentation transcript:

Thoracic Outlet Syndrome: Transaxillary Approach Margaret Clarke Tracci, MD, JD Operative Techniques in Thoracic and Cardiovascular Surgery Volume 16, Issue 4, Pages 267-277 (December 2011) DOI: 10.1053/j.optechstcvs.2012.01.001 Copyright © 2011 Terms and Conditions

Figure 1 Normal bony anatomy and neurovascular relationships of the thoracic outlet. a. = artery; m. = muscle; v. = vein. Operative Techniques in Thoracic and Cardiovascular Surgery 2011 16, 267-277DOI: (10.1053/j.optechstcvs.2012.01.001) Copyright © 2011 Terms and Conditions

Figure 2 Common bony anomalies in thoracic outlet syndrome. Operative Techniques in Thoracic and Cardiovascular Surgery 2011 16, 267-277DOI: (10.1053/j.optechstcvs.2012.01.001) Copyright © 2011 Terms and Conditions

Figure 3 Patient positioning and incision site for the transaxillary approach. Operative Techniques in Thoracic and Cardiovascular Surgery 2011 16, 267-277DOI: (10.1053/j.optechstcvs.2012.01.001) Copyright © 2011 Terms and Conditions

Figure 4 Operative exposure provided by the transaxillary approach. Operative Techniques in Thoracic and Cardiovascular Surgery 2011 16, 267-277DOI: (10.1053/j.optechstcvs.2012.01.001) Copyright © 2011 Terms and Conditions

Figure 5 Resection of the anterior scalene muscle, preserving the phrenic nerve. Operative Techniques in Thoracic and Cardiovascular Surgery 2011 16, 267-277DOI: (10.1053/j.optechstcvs.2012.01.001) Copyright © 2011 Terms and Conditions

Figure 6 Division of the middle scalene, preserving the long thoracic nerve. Operative Techniques in Thoracic and Cardiovascular Surgery 2011 16, 267-277DOI: (10.1053/j.optechstcvs.2012.01.001) Copyright © 2011 Terms and Conditions

Figure 7 Dissection of the inferior border of the first rib. Operative Techniques in Thoracic and Cardiovascular Surgery 2011 16, 267-277DOI: (10.1053/j.optechstcvs.2012.01.001) Copyright © 2011 Terms and Conditions

Figure 8 Resection of the first rib using the Roos first rib shear. Operative Techniques in Thoracic and Cardiovascular Surgery 2011 16, 267-277DOI: (10.1053/j.optechstcvs.2012.01.001) Copyright © 2011 Terms and Conditions

Figure 9 Completion of medial rib removal using the Kerrison rongeur may be, in the treatment of vTOS, accompanied by resection of the costoclavicular ligament, the subclavius tendon and muscle, and full venolysis. Operative Techniques in Thoracic and Cardiovascular Surgery 2011 16, 267-277DOI: (10.1053/j.optechstcvs.2012.01.001) Copyright © 2011 Terms and Conditions

Figure 10 Completion of lateral rib removal using the Kerrison rongeur. Operative Techniques in Thoracic and Cardiovascular Surgery 2011 16, 267-277DOI: (10.1053/j.optechstcvs.2012.01.001) Copyright © 2011 Terms and Conditions