complications. Less common are injuries to the thoracic duct and cervical sympathetic chain. Injuries to cutaneous nerves from either transaxillary or supraclavicular approaches are common. Plexus injury occurs from excessive traction, which at the time may not seem excessive. Plexus injury can also occur when a clamp on the subclavian artery to control bleeding accidentally includes a nerve of the plexus.

Plexus injury makes symptoms worse in 1% of patients. The incidence of temporary phrenic nerve injury during supraclavicular approaches is 10% because the phrenic nerve is often in the middle of the field and is very sensitive to even mild retraction.16 [Q7: K]

The results of surgery are about the same for all procedures. The biggest variable is etiology. When the etiology is an auto accident related injury, the 1-year success rate is 75–80%; when the etiology is repetitive stress at work or a work injury, the success rate is 15% lower.15,16,19 [Q8: B (for auto accident etiology), C (for work related and repetitive stress etiology)]

References

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 2. Gergoudis R, Barnes RW. Thoracic outlet arterial compression: prevalence in normal persons. Angiology. 1980;31:538-541.

 3. Sanders RJ, Haug CE. Thoracic Outlet Syndrome: A Common Sequela of Neck Injuries. Philadelphia: Lippincott; 1991:71-84.

 4. Sanders RJ, Hammond SL. Diagnosis of thoracic outlet syndrome. J Vasc Surg. 2007;46: 601-604.

 5. Upton ARM, McComas AJ. The double crush in nerve-entrapment syndromes. Lancet. 1973;2:359-362.

 6. Sanders RJ. Pectoralis minor syndrome. In: Eskandari MK, Morasch MD, Pearce WH, Yao JST, eds. Vascular Surgery: Therapeutic Strategies. Shelton: People’s Medical Publishing House; 2009:149-160.

 7. Sanders RJ, Rao NM. The forgotten pectoralis minor syndrome. 100 operations for pectoralis minor syndrome alone or accompanied by neurogenic thoracic outlet syndrome. Ann Vasc Surg 2010; 24:701-708.

 8. Gilliatt RW, Willison RG, Dietz V, Williams IR. Peripheral nerve conduction in patients with a cervical rib and band. Ann Neurol. 1978;4:124-129.

 9. Green RM, McNamara MS, Ouriel K. Long-term follow-up after thoracic outlet decompression: an analysis of factors determining outcome. J Vasc Surg. 1991;14:739-746.

10.Novak CB, Collins ED, Mackinnon SE. Outcome following conservative management of thoracic outlet syndrome. J Hand Surg. 1995;20A:542-548.

11.Roos DB. The place for scalenectomy and first rib resection in thoracic outlet syndrome. Surgery. 1982;92:1077-1085.

12.Sanders RJ, Pearce WH. The treatment of thoracic outlet syndrome: a comparison of different operations. J Vasc Surg. 1989;10:626-634.

13.Sanders RJ, Cooper MA, Hammond SL, Weinstein ES. Neurogenic thoracic outlet syndrome. In: Rutherford RB, ed. Vascular Surgery. 5th ed. Philadelphia: Saunders; 1999:1184-1200.

14.Cheng SWK, Reilly LM, Nelken NA, et al. Neurogenic thoracic outlet decompression: rationale for sparing the first rib. Cardiovasc Surg. 1995;3:617-623.

15.Thomas GI. Diagnosis and treatment of thoracic outlet syndrome. Perspect Vasc Surg. 1995;8:1-28.

16.Sanders RJ, Hammond SL. Complications and results of surgical treatment for thoracic outlet syndrome. Chest Surg Clin N Am. 1999;9:803-820.

17.Razi DM, Wassel HD. Traffic accident induced thoracic outlet syndrome: decompression without rib resection, correction of associated recurrent thoracic aneurysm. Int Surg. 1993;78:25-27.

18.Gockel M, Vastamaki M, Alaranta H. Long-term results of primary scalenotomy in the treatment of thoracic outlet syndrome. J Hand Surg. 1994;19B:229-233.

19.Ellison DW, Wood VE. Trauma-related thoracic outlet syndrome. J Hand Surg. 1994;19B: 424-426.