optmimal approach for venous TOS
 

Hello I am posting to see if anyone has any info. on the different approaches for Venous TOS surgery. I have been diagnosed with Venous TOS and have been recommended to undergo rib resection and scalenectomy. I have received a few opinions from vascular surgeons, some recommending a transaxiallary (under arm pit) approach and others Infraclavicular ( under collarbone) approach. If anyone has info. regarding these approaches as far as which one has the best results as well as better recovery I would appreciate it.

You can try a forum some of those search terms to find past posts on venous or various surgical techniques..

Vascular TOS surgeries generally have better outcomes, but as always seek out the best /skilled surgeon that you can find..
I think some surgeons have their own preferences for techniques or it may depend on the patient/and where the actual issue is.

Have you had clots from it, or lots of swelling and heaviness?

Robotic Thoracoscopic First Rib Resection for Paget-Schroetter Disease is an option you did not list.

Recovery is faster than what I read from other's experiences.

I have had a clot that was treated with thrombolysis as well as swelling and heaviness which have both mostly subsided since treatment

I'm sorry I don't know more about the statistics, but I had the infraclavicular approach done for my rib resection, scalenectomy, and aneurysm repair for arterial TOS. My surgeon was Dr. Thompson at Wash U. I had a very good outcome and was pleased with the entire process.

JR1977 thank you for the response, Do you mind telling me a little about your experience with the surgery and post op recovery time. How many nights in the hospital? And how long before the pain subsided and return to activities. I have seen posts about post op experiences with numbness in the chest area.

Sure. My surgery was 6-8 hours long (it's been almost 2 years, so I can't remember exactly). I was in the hospital for 4 nights. I slept a lot of that time. My pain was well-controlled with a morphine button, oral meds, and a "pain ball" near the location of the incision.

My parents stayed at the Parkway Hotel which is attached to Barnes Jewish Hospital, and then I stayed there for 2 nights after I was discharged from the hospital so that I would be there for a PT consult and a post-op appointment where I got my drain removed.

The pain was pretty bad early on, and I had to be sure to stay on top of it with the pain meds. I had plenty of meds, so it just kind of ended up being a concern about how sedated I wanted to be. After a few weeks, I really wanted to be able to be up and around more, so I started weaning off the meds. I went back to work half-time at 4 1/2 weeks, and by that time I was only taking hydrocodone at night (I was done with the OxyContin). I went back to work full-time at 5 1/2 weeks. I was still pretty tired and in some pain especially when I had to type a lot but generally did pretty well.

I was in PT for almost 9 months after my surgery. Overall I think my outcome was good. I still get some muscular pain off and on, but it's not nearly as bad as it was before my surgery. And now I don't have to worry about my aneurysm causing any problems. I do have some numbness right around the surgery site, but I don't notice it very much.

Please let me know if you have any other questions!

TOS surgery
 

Thanks again for the response.
Was your procedure strictley infraclavicular or suprclavicular as well?

I was curious how much of your rib was removed was it the whole rib or a section?

Also when you say you have muscular pain is that something you were dealing with prior to the surgery or as a results of the surgery?

Were both of your scalene (anterior and middle) removed and if so do you notice any difference without them, I have heard of people complaining about have neck stiffnes.

Are you able to return to any athletic activities without limitations and if so how long after the surgery were you able to.

Thanks for any responses you can provide?

Was your procedure strictley infraclavicular or suprclavicular as well? I'm not sure I know the exact locations of these descriptions. My incision is actually just above/over my collarbone - wish I could describe it better.

I was curious how much of your rib was removed was it the whole rib or a section? I had an extra/cervical rib, so I had that removed as well as the first rib (I think it was the whole first rib).

Also when you say you have muscular pain is that something you were dealing with prior to the surgery or as a results of the surgery? I've always had some muscular pain in my back. I think it's mostly due to stress/poor posture, etc. but it was worse before my surgery I think because my body was off balance due to everything going on on my right side (where I had the extra rib and aneurysm, etc. It still bothers me sometimes, but generally it's better. I go to a massage therapist, and that seems to help for the muscular pain/tension in my back.

Were both of your scalene (anterior and middle) removed and if so do you notice any difference without them, I have heard of people complaining about have neck stiffnes. Yes, I had both scalenes removed. Dr. Thompson said that mine were kind of mangled like everything else in that area on my right side. I don't have any more neck stiffness than I had before (again I think that's just related to working at a desk,typing, not taking as good of care of myself as I should, etc.)

Are you able to return to any athletic activities without limitations and if so how long after the surgery were you able to. I would say that after my 9 months of PT, I probably could have returned to most athletic activities, but I'm not very athletic, so I've mainly just done stretches, walking, that kind of thing, and of course that has been no problem. I did some swimming over the summer, and freestyle did aggravate it. But I think if I were so inclined, I could find a pretty good variety of athletic activities that I could do. I wouldn't say without limitations, though, because I still think I would have to try out different things to see how it worked for me.

Supraclavicular

Thank you for clarifying that!

My doctor favors the transaxillary approach (under the arm). I have not had surgery, so I can't comment on that.

Would like to hear any surgery stories for VTOS and the approach used.

I have bilateral venous TOS. I am one year post robotic rib resection which did nothing to help my symptoms. I have new issues that have crept up since surgery. TOS is a very individualized disease so surgical outcomes will vary. In regards to the robotic approach, the surgeon goes through the rib cage, deflates the lung, and then approaches the rib from the inside. They then remove the bony knuckle closest to the sternum leaving the rest of the rib and scalenes in tact. The surgical robot instruments and chest tube get close to the intercostal nerve which in my case left me with nerve damage. The surgeon only advised me of this possible side effect after I went through the procedure. The end result is pain, numbness, and shallow breathing with some days better than others. mix in some new emotional baggage to contend with. You should exhaust all other options before entertaining surgery regardless of the approach.

I had a supraclavicular first rib resection in May at MGH with Dr. Donahue for vTOS. (I had a DVT about a year before.) He's great.

I was off pain killers in less than a week. He wanted me to wait 3 months before resuming weight lifting. I felt ready much before that. But I took it easy to be safe.

I have absolutely no problems related to surgery. It's been about 7 months, but I was pretty much perfect at 4, just a little tightness near the scar back then. Some shirts still irritate it, but that's all.

One day last week I did 100 chin ups. No issues. None heavy squatting, deadlifting, or rowing. My subclavian seems to be improving. My hand gets a little dark, but the collaterals don't fill like they used to. And my left and right arms fatigue at the same time.

I'm very happy with the result.