I am going to another vascular surgeon next week.

Here are my questions so far. Do you have any to list?

1. How sure are we it is thoracic outlet?
2. What else could it be?
3. Explain the results of my duplex ultrasound of my subclavian arteries and veins? How bad is the blood flow? Where is it restricted specifically? What else can cause that? How does it compare to normal? to very very bad?
4. Can you tell if it is the nerve also that is being restricted?
5. I get numb pinkies and pressure/pain on the thumb side. How do the symptoms relate to what you think is going on?
6. Do you just want to remove the ribs?
7. What about removing scarring adhesions or scalenes?
8. What are the risks of surgery?
9. What side would you do first?
10. How many have you done? Success rate?

Surgical method: supraclavicular or transaxillary?

If rib resection then full scalenectomy or partial (scalenotomy)?

I would ask about his patients' usual recovery time and the average length of stay in the hospital.

If you have bilateral TOS, I would inquire about the length of time he suggests between the two surgeries. Due to various factors, I opted to have mine done 10 weeks apart. My surgeon said 6 weeks was the shortest he has done, and he recommends waiting longer than that whenever possible.

Sweet thanks!

So supraclavicular is reparing blood vessels and transaxillary is removing the ribs, which can be full scalenectomy (the whole rib) or partial (just some of the rib)?

Full is better because the knub of the rib can later rub, right?

am I following right?

full is better. I had my first done transaxillary and still having problems, which I am told the knub is rubbing. I have surgery scheduled for July18 this time supraclavicular.

The surgeon can remove the ribs both ways, but some prefer one way vs the other. A surgeon I saw today preferred supraclavicular because transaxillary you can't reach up as far without stretching the nerves which leaves more room for nerve damage but that is because he wants to remove my cervical rib. Scalenectomy means removing the scalene muscles in addition to removing the rib. You can either have full (all of it) or partial (some of the muscle) removed. And from the research I've done, it seems full rib removal is the better option to reduce your chance of recurrence.

These links may help you follow better:

http://morphopedics.wikidot.com/thor...-syndrome#toc9
http://surgery.wustl.edu/TOS_Patients_Neurogenic.aspx

Partial rib resections are not desirable regardless of the approach as they have been shown to increase the chance of recurrence due to scarring/adhesions. So make sure your surgeon is planning to remove the entire rib from sternum to spine.

Once you have chosen a surgeon, it is best not to get hung up on transaxillary vs supraclavicular approach as there are pros and cons to each and each surgeon has a preference based on experience. It is fine to ask why they prefer a particular approach and specifically what the plan for your surgery is.

I just found out he thinks I have Neurogenic compression of the Brachial plexus and he wants to do decompression of the thoracic outlet and decompress the area where the vein gets pinched occasionally.

Does anyone have anymore questions to add? I am going to see a new surgeon as well. Thanks! (I have arterial TOS).