Thoracic outlet syndrome: a 50-year experience at Baylor University Medical Center
Harold C. Urschel, Jr., MD, and Harry Kourlis, Jr., MD
During the past 5 decades, the recognition and management of thoracic
outlet syndrome (TOS) have evolved. This article elucidates these changes
and improvements in the diagnosis and management of TOS at Baylor
University Medical Center. The most remarkable change over the past
50 years is the use of nerve conduction velocity to diagnose and monitor
patients with nerve compression. Recognition that procedures such
as breast implantation and median sternotomy may produce TOS has
been revealing. Prompt thrombolysis followed by surgical venous decompression
for Paget-Schroetter syndrome has markedly improved results
compared with the conservative anticoagulation approach; thrombolysis
and prompt first rib resection is the optimal treatment for most patients
with Paget-Schroetter syndrome. Complete first rib extirpation at the initial
procedure markedly reduces the incidence of recurrent neurologic symptoms
or the need for a second procedure. Chest pain or pseudoangina
can be caused by TOS. Dorsal sympathectomy is helpful for patients with
sympathetic maintained pain syndrome or causalgia and patients with
recurrent TOS symptoms who need a second procedure.
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