FOR THE MEDICAL PRACTITIONER
Cardiovascular Surgery
doi: 10.25005/2074-0581-2026-28-1-238-251
SURGICAL TREATMENT OF THORACIC OUTLET SYNDROME

D.D. SULTANOV1,2, A.D. GAIBOV1, D.A. RAKHMONOV1, O. NEMATZODA1,2, F.M. MAKHMADALIZODA1

1Republican Scientific Center for Cardiovascular Surgery, Dushanbe, Republic of Tajikistan
2Department of Surgical Diseases No. 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan

Objective: The study aimed to optimize management tactics and the choice of surgical interventions to improve treatment outcomes for patients with extravascular compression of the neurovascular bundle (NVB) in thoracic outlet syndrome (TOS).

Methods: The results of complex diagnostics and treatment were studied in 521 patients (mean age 31.2±2.6 years; 27.1% (n=131) men and 74.9% (n=390) women) with various forms of TOS. Costoclavicular syndrome (CCS) was present in 51.8% (n=270) patients, complete accessory cervical rib (ACR) in 26.9% (n=140), rudimentary cervical rib (RCR) in 12.8% (n=67), scalene syndrome (SS) in 5.0% (n=26), and pectoralis minor syndrome (PMS) in 3.5% (n=18). Raynaud's phenomenon (RP) was also observed in 63.0% (n=328) patients. To diagnose TOS and the severity of NVB compression, functional tests, nitroglycerin and cold tests, and imaging methods – radiography, CT, duplex scanning with Doppler blood flow mapping, and electroneuromyography (ENMG) – were used.

Results: Clinical manifestations of TOS depended on the compression component. The arterial form presented with positional ischemia of the arm and thromboembolism of the palmar arterial arch. Cases with predominant nerve compression presented with shoulder girdle pain, hand muscle atrophy, and rapid upper limb fatigue. The venous form was characterized by hypertension in the subcutaneous venous system, often with thrombotic occlusion of the axillary-subclavian segment. Decompression surgeries were performed for all forms of TOS; in 339 cases, these were supplemented by upper thoracic sympathectomy, and in 16 cases by arterial revascularization. There were no fatalities during the hospital period. Intraoperative complications occurred in 2.5% (n=13) of patients, and early postoperative complications occurred in 7.7% (n=40). Long-term positive results were recorded in 91.9% of patients with CCS, 90.7% with ACR, 83.6% with RCR, and 100.0% with SS and PMS.

Conclusion: Common features across all types of TOS included NVB compression with corresponding clinical manifestations, combined with alternating bouts of vasospasm (63.0%). Optimized management tactics and surgical methods for TOS have improved the quality of specialized care. The high rate of successful outcomes across all forms of TOS demonstrates the effectiveness of decompression surgery.

Keywords: Thoracic outlet syndrome, diagnosis, arterial complications, rib resection, decompression, cervicothoracic sympathectomy.

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Authors' information:

Sultanov Dzhavli Davronovich,
Doctor of Medical Sciences, Full Professor, Deputy Director for Science, Republican Scientific Center for Cardiovascular Surgery; Professor of the Department of Surgical Diseases No. 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
Researcher ID: AAC-7784-2019
Scopus ID: 36922139600
ORCID ID: 0000-0001-7935-7763
SPIN: 9762-8395
Author ID: 445360
E-mail: sultanov57@mail.ru

Gaibov Alidzhon Dzhuraevich,
Corresponding Member of National Academy of Sciences of Tajikistan, Doctor of Medical Sciences, Full Professor, Professor of the Department of Surgical Diseases No. 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University
Researcher ID: AAC-9879-2020
Scopus ID: 6602514987
ORCID ID: 0000-0002-3889-368X
SPIN: 5152-0785
Author ID: 293421
E-mail: gaibov_a.d@mail.ru

Rakhmonov Dzhamakhon Akhmadovich,
Candidate of Medical Sciences, Director, Republican Scientific Center for Cardiovascular Surgery
Researcher ID: AAT-2441-2020
ORCID ID: 0000-0002-4427-0155
SPIN: 4201-0747
Author ID: 1077348
E-mail: jama-7878@mail.ru

Nematzoda Okildzhon,
Candidate of Medical Sciences, Associate Professor of the Department of Surgical Diseases No. 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University; Leading Researcher, Republican Scientific Center for Cardiovascular Surgery
Researcher ID: F-8729-2018
Scopus ID: 56469644700
ORCID ID: 0000-0001-7602-7611
SPIN: 2408-9107
Author ID: 929575
E-mail: sadriev_o_n@mail.ru

Makhmadalizoda Fayziddin
Makhmadali, Candidate of Medical Sciences, Applicant, Republican Scientific Center for Cardiovascular Surgery
ORCID ID: 0000-0001-5954-9522
SPIN: 7517-0607
Author ID: 916-624
E-mail: dr.Fayzidin@mail.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Sultanov Dzhavli Davronovich
Doctor of Medical Sciences, Full Professor, Deputy Director for Science, Repub- lican Scientific Center for Cardiovascular Surgery; Professor of the Department of Surgical Diseases No. 2 named after Academician N.U. Usmanov, Avicenna Tajik State Medical University

734003, Republic of Tajikistan, Dushanbe, Sanoi str., 33

Tel.: +992 (918) 334115

E-mail: sultanov57@mail.ru


This work is licensed under a Creative Commons Attribution 4.0 International License.

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