Do you mean transaxial? I have never heard of transternal either.

Nope, transternal so he can get both sides. He wants to be able to see everything and get the entire rib. He's going to cut clear across my chest right under the collarbone.

I've never heard of this approach and it sounds unnecessarily risky. Have you least found a journal article on this? I wouldn't rush into this and I don't recommend having both sides done at the same time.

Yes, I did find a journal article on it. It seems like the go-to approach when both sides need to be done at once due to artery compromise and the best way to get a good look at all artery damage. I guess it's not the perfect approach, but when arteries are the problem that's what they recommend. The journal says that the outcomes are good from the surgery. If you're a non-smoker and young (which I am) you heal up from it quite will with no additional complications from it. I think he's downplayed how bad things are getting with blood flow because he very sternly told me that even though my right side is not near as symptomatic that it can't wait and absolutely needs to be done.

this is what he did for my friend. Both sides at once. and he fixed her veins which were blocked.

I wish you great luck and hope the best for you. Please keep us posted on your progress.

Post the journal article if you can.

I can't find the article I read last night (of course) but I did find this which seems to be more helpful. I guess another word for the approach is infraclavicular but because he's doing it bilaterally it crosses the sternum calling it a transsternal.


"Infraclavicular First Rib Resection
The patient is positioned supine with a pad to elevate the scapula and shoulder, with the arm abducted. A muscle-splitting incision approximately 12 cm in length is carried through the pectoralis major muscle to expose the first rib below the clavicle, beginning medially at the costochondral junction. The periosteum is elevated subperiosteally from the rib, and the costochondral junction is removed piecemeal with the Leksell rongeur. The pleura can then be stripped from the posterior surface of the mobilized rib with careful blunt dissection. The rib is next retraced inward, and the neurovascular bundle traversing the costoclavicular space is palpated and retracted with the index finger. With the neurovascular structures thus constantly protected beneath the index finger and the pleura retracted, the rib with its periosteum is rongeured away, scraping off the insertions of the anterior and middle scalene muscles. Posterior to the neurovascular bundle, rib removal is accomplished by feel rather than under direct vision, but usually can be taken back to within 3 to 4 cm of the transverse process without excessive retraction of the neurovascular bundle; and in some asthenic patients, to within 1 to 2 cm of the transverse process. If a cervical rib is present,
5
it can also be trimmed through this approach. This incision can be extended slightly downward to the deltopectoral junction if the pectoralis minor tendon is to be divided. If a tear occurs in the pleura, it is closed around catheter suction with the lung inflated. The pectoral fascia, subcutaneous tissue, and skin are closed in layers. Bilateral rib resection can be done as a one-stage procedure by this technique."