Surgery for Thoracic Outlet Syndrome

Doctors at our NYU Langone heart programs perform procedures to relieve the compression of veins and arteries in the thoracic outlet. They may, for instance, widen arteries or remove muscle or ribs.

When deciding if surgery is right for you, your doctor considers the level of compression and which veins, arteries, and nerves are affected.

Rib Resection

People with damage to an artery or vein are typically treated with a rib resection. People with neurogenic thoracic outlet compression, may have a rib resection if physical therapy hasn’t alleviated their symptoms.

In a rib resection, your NYU Langone surgeon widens the thoracic outlet by removing an extra rib and possibly the muscles attached to it. Surgery may also involve removing scar tissue caused by repetitive use of an arm or shoulder that may be compressing adjacent nerves and muscles.

Performed using general anesthesia, a rib resection begins with an incision above the clavicle or under the arm. The surgeon cuts and removes the extra rib and closes the incision with stitches, which dissolve in a few weeks. 

This surgery takes about two hours to complete and requires a one- to three-day stay in the hospital. Recovery can take several weeks, during which your doctor may recommend restricting activities.

Balloon Angioplasty and Venoplasty

Our vascular surgeons may perform minimally invasive procedures called balloon angioplasty or balloon venoplasty. 

Balloon angioplasty helps open narrowed arteries in the arm and chest after a rib resection in people with arterial thoracic outlet syndrome. Balloon venoplasty opens narrowed veins in the arm and chest caused by venous thoracic outlet syndrome

Using local anesthesia, your surgeon punctures the arm with a needle, then inserts a catheter with an inflatable balloon at the tip into an artery or vein. He or she then guides the catheter to the narrowed space between your first rib and collarbone. 

Each procedure lasts 30 to 90 minutes, depending on the severity of the blockage. Typically, you return home on the day of the procedure.

Scalenectomy

In a scalenectomy, the scalene muscles—which pass through the thoracic outlet—are removed to reduce compression on the nerves, arteries, and veins in the area. This helps to reduce pain and prevent blood clots in people with neurogenic thoracic outlet syndrome. The procedure may be performed in conjunction with surgery to remove an extra rib. 

In this procedure, which is performed with general anesthesia, the doctor makes a small incision above the clavicle, or collarbone. If a rib is also being removed, an incision is made under the arm. The scalene muscles causing compression of nerves, vessels, or arteries are removed. The incision is closed with stitches that dissolve, typically within a few weeks.

This surgery takes up to two hours and typically requires an overnight stay in the hospital. Recovery can take a few weeks, during which your doctor may recommend restricting activities.

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